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General NPI Number Information
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NPI Number | 1578441408
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Entity Type | Organization
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Legal Business Name | STOCKBRIDGE DENTAL SMILES LLC
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Dates
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Enumeration Date | 08/27/2025
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 5473 N HENRY BLVD STE 1
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-3261
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Country | US
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Telephone | 678-807-3635
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Fax |
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Provider Business Mailing Address
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Address Line | 2705 AZALEA BLUFF DR
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City | CUMMING
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State | GA
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Zip | 30041-3207
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Country | US
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Telephone | 770-205-0466
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PRAVEEN REDDY GUDIPATI
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Credential | D.M.D.
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Telephone | 770-205-0466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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