Provider Demographics
NPI:1144351479
Name:SUDANAGUNTA, SOUJANYA (DDS)
Entity type:Individual
Prefix:DR
First Name:SOUJANYA
Middle Name:
Last Name:SUDANAGUNTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7044 DUBLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-3017
Mailing Address - Country:US
Mailing Address - Phone:925-556-6267
Mailing Address - Fax:925-556-6123
Practice Address - Street 1:7044 DUBLIN BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-3017
Practice Address - Country:US
Practice Address - Phone:925-556-6267
Practice Address - Fax:925-556-6123
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA557121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice