Provider Demographics
NPI:1942723507
Name:BASIREDDYGARI, SOWJANYA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SOWJANYA
Middle Name:
Last Name:BASIREDDYGARI
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 1:15801 ROLATER RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035
Mailing Address - Country:US
Mailing Address - Phone:469-353-6886
Mailing Address - Fax:469-353-6883
Practice Address - Street 1:15801 ROLATER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035
Practice Address - Country:US
Practice Address - Phone:469-353-6886
Practice Address - Fax:469-353-6883
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33311122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist