MEDICARE: DR. SAI GOOLLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	37924	TX

General Provider Information

NPI Number	:	1023774544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAI GOOLLA

Provider Business Mailing Address
First Line	:	7200 ALMEDA RD APT 405
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2147
Country	:	US
Telephone Number	:	713-302-4432
Fax Number	:

Provider Business Practice Location Address
First Line	:	1173 EDGEBROOK DR STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77034-1862
Country	:	US
Telephone Number	:	713-325-5186
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2021
Last Update Date	:	11/09/2021

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Directions to “ DR. SAI GOOLLA ” Practice Location

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