Provider Demographics
NPI:1356642516
Name:GUMMADI, ASHA KIRAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ASHA KIRAN
Middle Name:
Last Name:GUMMADI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 S DOBSON RD STE M3
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6231
Mailing Address - Country:US
Mailing Address - Phone:480-793-7354
Mailing Address - Fax:480-771-8500
Practice Address - Street 1:3260 N TOLTEC RD
Practice Address - Street 2:
Practice Address - City:ELOY
Practice Address - State:AZ
Practice Address - Zip Code:85131-9661
Practice Address - Country:US
Practice Address - Phone:520-466-3920
Practice Address - Fax:520-466-3921
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD85271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice