NPIMap

Organization Active NPI

Siddhi Anitha Prasanna

  • Dentist
  • Titusville, FL
National Provider Identifier
1407212558
Registry record updated Jan 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
SIDDHI ANITHA PRASANNA
Practice address
815 Cheney Hwy
Titusville, FL 32780-6960
Phone
(321) 268-0108
Fax
(321) 269-6033
NPI assigned
Jan 5, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Glenna Morris
Title
Admin Officer
Phone
(321) 268-0108

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

815 Cheney Hwy
Titusville, FL 32780-6960

Mailing address

815 Cheney Hwy
Titusville, FL 32780-6960
Phone (321) 268-0108

Other names 1

  • Stellar Smile Family Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Siddhi Anitha Prasanna2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1451952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451952000000",
    "number": "1407212558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 CHENEY HWY",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327806960",
            "telephone_number": "321-268-0108",
            "fax_number": "321-269-6033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 CHENEY HWY",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327806960",
            "telephone_number": "321-268-0108",
            "fax_number": "321-269-6033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIDDHI ANITHA PRASANNA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-05",
        "last_updated": "2016-01-05",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "GLENNA",
        "authorized_official_title_or_position": "ADMIN OFFICER",
        "authorized_official_telephone_number": "321-268-0108"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stellar Smile Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Titusville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.