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General NPI Number Information
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NPI Number | 1639035587
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Entity Type | Organization
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Legal Business Name | DOUGLASVILLE DENTAL SMILES
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 3387 HIGHWAY 5 STE D
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-6900
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Country | US
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Telephone | 678-653-8998
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Fax |
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Provider Business Mailing Address
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Address Line | 3387 HIGHWAY 5 STE D
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-6900
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Country | US
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Telephone | 678-653-8998
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. PRAVEEN REDDY GUDIPATI
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Credential | DMD
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Telephone | 404-966-7766
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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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