Provider Demographics
NPI:1407378524
Name:GATTUMEEDHI, SHASHANK REDDY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHASHANK REDDY
Middle Name:
Last Name:GATTUMEEDHI
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 1:1595 GLIDEWELL DR STE 104
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8254
Mailing Address - Country:US
Mailing Address - Phone:336-524-0099
Mailing Address - Fax:
Practice Address - Street 1:1600 CROSS LINK RD STE 103-104
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1089
Practice Address - Country:US
Practice Address - Phone:919-615-2885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC116331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice