Provider Demographics
NPI:1184935793
Name:GUTTI, SUDHA R (DMD)
Entity type:Individual
Prefix:DR
First Name:SUDHA
Middle Name:R
Last Name:GUTTI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SUDHA
Other - Middle Name:R
Other - Last Name:KASINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2323 MOODY PKWY
Mailing Address - Street 2:
Mailing Address - City:MOODY
Mailing Address - State:AL
Mailing Address - Zip Code:35004-3012
Mailing Address - Country:US
Mailing Address - Phone:205-640-1717
Mailing Address - Fax:
Practice Address - Street 1:2323 MOODY PKWY
Practice Address - Street 2:
Practice Address - City:MOODY
Practice Address - State:AL
Practice Address - Zip Code:35004-3012
Practice Address - Country:US
Practice Address - Phone:205-640-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL57861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice