Healthcare Provider Details

I. General information

NPI: 1942994652
Provider Name (Legal Business Name): SAI VINEETHA DUDDU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S MADISON ST STE P
WEBB CITY MO
64870-2426
US

IV. Provider business mailing address

2040 LAQUESTA DRIVE
NEOSHO MO
64850
US

V. Phone/Fax

Practice location:
  • Phone: 417-392-6090
  • Fax:
Mailing address:
  • Phone: 417-451-1566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2023020511
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: