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General NPI Number Information
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NPI Number | 1326278300
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Entity Type | Individual
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Provider Name | SAI VENKATA MAHESH GUDURU
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Gender | Male
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Dates
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Enumeration Date | 07/23/2009
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 5015 W RIDGE RUN
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City | CANANDAIGUA
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State | NY
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Zip | 14424-2731
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Country | US
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Telephone | 617-416-0270
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Fax |
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Provider Business Mailing Address
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Address Line | 430 W ERIE ST STE 200
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City | CHICAGO
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State | IL
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Zip | 60654-6914
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Country | US
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Telephone | 312-274-0308
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Fax | 312-944-9499
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 059482-01
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License Number State | NY
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