Provider Demographics
NPI:1255498903
Name:ANIL GUDAPATI DMD PA
Entity Type:Organization
Organization Name:ANIL GUDAPATI DMD PA
Other - Org Name:KIDS DENTAL SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:PRAKASH
Authorized Official - Last Name:GUDAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:512-259-2331
Mailing Address - Street 1:601 E WHITESTONE BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613
Mailing Address - Country:US
Mailing Address - Phone:512-259-2331
Mailing Address - Fax:512-259-9887
Practice Address - Street 1:601 E WHITESTONE BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613
Practice Address - Country:US
Practice Address - Phone:512-259-2331
Practice Address - Fax:512-259-9887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX219821223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty