Healthcare Provider Details

I. General information

NPI: 1932839693
Provider Name (Legal Business Name): SAI PREETI GUDLA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 S VOLUSIA AVE
ORANGE CITY FL
32763-7022
US

IV. Provider business mailing address

1025 S VOLUSIA AVE
ORANGE CITY FL
32763-7022
US

V. Phone/Fax

Practice location:
  • Phone: 386-775-9933
  • Fax: 386-775-9604
Mailing address:
  • Phone: 386-775-9933
  • Fax: 386-775-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN27030
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: