Provider Demographics
NPI:1063596252
Name:MADASU, SUNITHA R (DMD)
Entity type:Individual
Prefix:
First Name:SUNITHA
Middle Name:R
Last Name:MADASU
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 1:1845 DARBY DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-2622
Mailing Address - Country:US
Mailing Address - Phone:256-767-7600
Mailing Address - Fax:256-767-0490
Practice Address - Street 1:1845 DARBY DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-2622
Practice Address - Country:US
Practice Address - Phone:256-767-7600
Practice Address - Fax:256-767-0490
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL48021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice