Provider Demographics
NPI:1275178865
Name:A GUD DENTIST, PLLC
Entity Type:Organization
Organization Name:A GUD DENTIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUDIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:682-234-9168
Mailing Address - Street 1:3010 FM 423 STE 100
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-6705
Mailing Address - Country:US
Mailing Address - Phone:469-239-0123
Mailing Address - Fax:469-213-1524
Practice Address - Street 1:3010 FM 423
Practice Address - Street 2:#100
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068
Practice Address - Country:US
Practice Address - Phone:214-945-0901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental