Healthcare Provider Details

I. General information

NPI: 1447313135
Provider Name (Legal Business Name): ANIL GUDAPATI D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E WHITESTONE BLVD SUITE 400
CEDAR PARK TX
78613-9015
US

IV. Provider business mailing address

601 E WHITESTONE BLVD SUITE 400
CEDAR PARK TX
78613-9015
US

V. Phone/Fax

Practice location:
  • Phone: 512-259-2331
  • Fax: 512-259-9887
Mailing address:
  • Phone: 512-259-2331
  • Fax: 512-259-9887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number21982
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: