Healthcare Provider Details

I. General information

NPI: 1184935793
Provider Name (Legal Business Name): SUDHA R GUTTI D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUDHA R. KASINA

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 MOODY PKWY
MOODY AL
35004-3012
US

IV. Provider business mailing address

2323 MOODY PKWY
MOODY AL
35004-3012
US

V. Phone/Fax

Practice location:
  • Phone: 205-640-1717
  • Fax:
Mailing address:
  • Phone: 205-640-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5786
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: