Provider Demographics
NPI:1376422816
Name:GUNDIMEDA, NAGA SAI PRANATHI (DMD)
Entity type:Individual
Prefix:DR
First Name:NAGA SAI PRANATHI
Middle Name:
Last Name:GUNDIMEDA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2390 STONE FENCE LN
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-5367
Mailing Address - Country:US
Mailing Address - Phone:571-524-7818
Mailing Address - Fax:
Practice Address - Street 1:2390 STONE FENCE LN
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-5367
Practice Address - Country:US
Practice Address - Phone:571-524-7818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401419659122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist