MEDICARE: DIYA DENTAL PLLC

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

General Provider Information

NPI Number	:	1215829148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIYA DENTAL PLLC

Provider Business Mailing Address
First Line	:	6600 CRISTO LN
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-7377
Country	:	US
Telephone Number	:	713-714-3805
Fax Number	:

Provider Business Practice Location Address
First Line	:	27052 E UNIVERSITY DR STE 105
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	76227
Country	:	US
Telephone Number	:	940-290-6835
Fax Number	:	940-274-9191

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	SRUJANI REDDY GADUSU
Credential	:	DDS
Telephone Number	:	713-714-3805

Provider Enumeration Date	:	07/16/2025
Last Update Date	:	07/16/2025

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