=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215829148
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIYA DENTAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2025
-----------------------------------------------------
Last Update Date | 07/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27052 E UNIVERSITY DR STE 105
-----------------------------------------------------
City | LITTLE ELM
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-290-6835
-----------------------------------------------------
Fax | 940-274-9191
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6600 CRISTO LN
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75070-7377
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-714-3805
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER DENTIST
-----------------------------------------------------
Name | SRUJANI REDDY GADUSU
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 713-714-3805
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------