Provider Demographics
NPI:1629630074
Name:GUDETI, ANURAG R (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANURAG
Middle Name:R
Last Name:GUDETI
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 1:1644 BRUCE B DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-8600
Mailing Address - Country:US
Mailing Address - Phone:248-885-3807
Mailing Address - Fax:
Practice Address - Street 1:1644 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-8600
Practice Address - Country:US
Practice Address - Phone:813-333-5277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-06
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25738122300000X
MI2901600218122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist