MEDICARE: DOUGLASVILLE DENTAL SMILES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1639035587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLASVILLE DENTAL SMILES

Provider Business Mailing Address
First Line	:	3387 HIGHWAY 5 STE D
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30135-6900
Country	:	US
Telephone Number	:	678-653-8998
Fax Number	:

Provider Business Practice Location Address
First Line	:	3387 HIGHWAY 5 STE D
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30135-6900
Country	:	US
Telephone Number	:	678-653-8998
Fax Number	:

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. PRAVEEN REDDY GUDIPATI
Credential	:	DMD
Telephone Number	:	404-966-7766

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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