Healthcare Provider Details

I. General information

NPI: 1134506330
Provider Name (Legal Business Name): GIRIJA V NAIDU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 ELMWOOD AVE
ROCHESTER NY
14620
US

IV. Provider business mailing address

1603 S HIAWASSEE RD STE 135
ORLANDO FL
32835-6439
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-5087
  • Fax: 585-273-1235
Mailing address:
  • Phone: 407-293-8324
  • Fax: 407-298-7810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN23315
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: