Provider Demographics
NPI:1457513228
Name:DUGGIRALA, SRIDEVI (DMD)
Entity Type:Individual
Prefix:
First Name:SRIDEVI
Middle Name:
Last Name:DUGGIRALA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SRIDEVI
Other - Middle Name:
Other - Last Name:BOPPANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:400 GALLERIA PKWY SE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5980
Mailing Address - Country:US
Mailing Address - Phone:770-916-5352
Mailing Address - Fax:678-302-7121
Practice Address - Street 1:137 HATHAWAY RD
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02746-1304
Practice Address - Country:US
Practice Address - Phone:508-992-7668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice