Provider Demographics
NPI:1629471743
Name:NADIKUDA, SWAPNA (DMD)
Entity Type:Individual
Prefix:
First Name:SWAPNA
Middle Name:
Last Name:NADIKUDA
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 1:8801 SPRINGSBURY PL
Mailing Address - Street 2:APT #5
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-7214
Mailing Address - Country:US
Mailing Address - Phone:502-271-0953
Mailing Address - Fax:
Practice Address - Street 1:8801 SPRINGSBURY PL
Practice Address - Street 2:APT #5
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-7214
Practice Address - Country:US
Practice Address - Phone:502-271-0953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY94781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9478Medicaid
KY9478Medicaid
KY9478Medicare PIN