MEDICARE: DR. SUDHA GUTTI, DMD. INC.

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	261QD0000X	Dental Clinic/Center	5786	AL

General Provider Information

NPI Number	:	1679848238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. SUDHA GUTTI, DMD. INC.

Provider Business Mailing Address
First Line	:	3710 CHALYBE WALK
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35226-6282
Country	:	US
Telephone Number	:	205-833-5405
Fax Number	:	205-833-5091

Provider Business Practice Location Address
First Line	:	612 RED LANE RD
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35215-8236
Country	:	US
Telephone Number	:	205-833-5405
Fax Number	:	205-833-5091

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SUDHA RANI GUTTI
Credential	:	DMD
Telephone Number	:	205-833-5405

Provider Enumeration Date	:	03/15/2012
Last Update Date	:	03/15/2012

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