MEDICARE: SRUJANI REDDY GADUSU DDS

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	122300000X	Dentist	35854	TX
2	1223G0001X	General Practice Dentistry	DS042245	PA

General Provider Information

NPI Number	:	1417518457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SRUJANI REDDY GADUSU DDS

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	:	2091 N COLLINS BLVD # 100
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75080-2636
Country	:	US
Telephone Number	:	972-644-3800
Fax Number	:

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

Provider Enumeration Date	:	06/20/2019
Last Update Date	:	10/13/2022

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