Organization
SHREE ANITHA PRASANNA PA
Active
Other names
Space Coast Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
SHREE ANITHA PRASANNA (ADMINISTRATOR OFFICER)
(321) 268-0108
Entity
Organization
Contact information
Practice address
1490 CHENEY HWY, TITUSVILLE, FL 32780-6250
(321) 267-3304
(321) 267-9191
Mailing address
1490 CHENEY HWY, TITUSVILLE, FL 32780-6250
(321) 267-3304
(321) 267-9191
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
11/25/2015
Last updated
03/28/2025
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