NPIMap

Organization Active NPI

Avanthi Kopuri, DMD, MSD, Mha, PLLC

Doing business as Central Florida Orthodontic Specialists

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Rockledge, FL
National Provider Identifier
1861896474
Registry record updated Aug 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
P00000094134 Issued in FL
Legal business name
AVANTHI KOPURI, DMD, MSD, MHA, PLLC
Doing business as
Central Florida Orthodontic Specialists
Practice address
3010 S Fiske Blvd
Rockledge, FL 32955-4302
Phone
(321) 638-4455
Fax
(321) 638-1203
NPI assigned
Oct 13, 2014
Last updated
Aug 28, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2020

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

Authorized official

Name
Dr. Avanthi Kopuri, DMD, MSD, MHA
Title
President
Phone
(305) 788-4415

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X P00000094134 FL Primary

Addresses

Primary practice location

3010 S Fiske Blvd
Rockledge, FL 32955-4302

Mailing address

3010 S Fiske Blvd
Rockledge, FL 32955-4302
Phone (321) 638-4455

Other names 1

  • Central Florida Orthodontic Specialists Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Avanthi Kopuri DMD MSD Mha PLLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

3010 S Fiske Blvd
Rockledge, FL 32955
Phone (321) 638-4455

NPI Registry JSON

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

{
    "created_epoch": "1413158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598572800000",
    "number": "1861896474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3010 S FISKE BLVD",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329554302",
            "telephone_number": "321-638-4455",
            "fax_number": "321-638-1203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3010 S FISKE BLVD",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329554302",
            "telephone_number": "321-638-4455",
            "fax_number": "321-638-1203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVANTHI KOPURI, DMD, MSD, MHA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-13",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-28",
        "status": "A",
        "authorized_official_last_name": "KOPURI",
        "authorized_official_first_name": "AVANTHI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-788-4415",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MSD, MHA"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "FL",
            "license": "P00000094134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Florida Orthodontic Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rockledge, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; 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.