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General NPI Number Information
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NPI Number | 1841605789
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Entity Type | Individual
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Provider Name | SOUMYA PADALA BDS, MDS, MS
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Gender | Female
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 1430 JOHN WESLEY GILBERT DRIVE
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City | AUGUSTA
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State | GA
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Zip | 30912-0001
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Country | US
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Telephone | 706-721-2371
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Fax | 706-721-6778
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Provider Business Mailing Address
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Address Line | 1430 JOHN WESLEY GILBERT DRIVE
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City | AUGUSTA
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State | GA
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Zip | 30912-0001
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Country | US
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Telephone | 706-721-2371
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Fax | 706-721-6778
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019030497
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 021002710
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DNF000467
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License Number State | GA
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