Individual provider Active NPI

Anusha Bontha, DMD

  • General Practice Dentistry
  • Lakeland, FL
National Provider Identifier
1699647115
Registry record updated Sep 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN27656 Issued in FL
Practice address
4969 US Highway 98 N
Lakeland, FL 33809-3657
Phone
(863) 614-0044
NPI assigned
Sep 23, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN27656 FL Primary

Addresses

Primary practice location

4969 US Highway 98 N
Lakeland, FL 33809-3657

Mailing address

600 Technology Park Ste 101
Lake Mary, FL 32746-7122
Phone (407) 543-8514

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DN27656FLMDGeneral Practice Dentistry

Networks

  • Freedom Health HMO Network

NPI Registry JSON

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

{
    "created_epoch": "1758585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758585600000",
    "number": "1699647115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 TECHNOLOGY PARK STE 101",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327467122",
            "telephone_number": "407-543-8514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4969 US HIGHWAY 98 N",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338093657",
            "telephone_number": "863-614-0044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONTHA",
        "first_name": "ANUSHA",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-23",
        "last_updated": "2025-09-23",
        "certification_date": "2025-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN27656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2025; 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.