Provider Demographics
NPI:1669796116
Name:GOUTAREDDY, SNIGDA (DMD)
Entity type:Individual
Prefix:DR
First Name:SNIGDA
Middle Name:
Last Name:GOUTAREDDY
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 1:2525 OLD FARM RD APT 516
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-4414
Mailing Address - Country:US
Mailing Address - Phone:713-775-1731
Mailing Address - Fax:
Practice Address - Street 1:8535 W BELLFORT ST STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-2264
Practice Address - Country:US
Practice Address - Phone:713-777-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX242671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice