Provider Demographics
NPI:1952129421
Name:VUDUDALA, BHARGAVI (DDS)
Entity type:Individual
Prefix:DR
First Name:BHARGAVI
Middle Name:
Last Name:VUDUDALA
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5616 POOLEY LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-2191
Mailing Address - Country:US
Mailing Address - Phone:774-301-5632
Mailing Address - Fax:
Practice Address - Street 1:203 ROCKY RD
Practice Address - Street 2:
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-2863
Practice Address - Country:US
Practice Address - Phone:774-301-5632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110856122300000X
TX40949122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist