Healthcare Provider Details

I. General information

NPI: 1891498408
Provider Name (Legal Business Name): ANIRUDH SAI PIDUGU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 SAINT NICHOLAS AVE APT 2F
NEW YORK NY
10031-2920
US

IV. Provider business mailing address

813 SAINT NICHOLAS AVE APT 2F
NEW YORK NY
10031-2920
US

V. Phone/Fax

Practice location:
  • Phone: 501-400-5254
  • Fax:
Mailing address:
  • Phone: 501-400-5254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number065734
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: