Individual
DR. THYAGASEELY PREMARAJ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.D.S, PHD
Contact information
Practice address
3200 S UNIVERSITY DR, DAVIE, FL 33328-2018
(954) 262-7213
(954) 262-7355
Mailing address
PO BOX 290370, FT LAUDERDALE, FL 33329-0370
(954) 262-4346
(954) 262-2269
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
118
NE
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DTP716
FL
Other
Enumeration date
03/15/2011
Last updated
09/23/2020
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