Healthcare Provider Details

I. General information

NPI: 1356642516
Provider Name (Legal Business Name): ASHA KIRAN GUMMADI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 N TOLTEC RD
ELOY AZ
85131-9661
US

IV. Provider business mailing address

255 S DOBSON RD STE M3
CHANDLER AZ
85224-6231
US

V. Phone/Fax

Practice location:
  • Phone: 520-466-3920
  • Fax: 520-466-3921
Mailing address:
  • Phone: 480-793-7354
  • Fax: 480-771-8500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD8527
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: