Provider Demographics
NPI:1154584076
Name:MADALA, SWETHA (DDS)
Entity type:Individual
Prefix:DR
First Name:SWETHA
Middle Name:
Last Name:MADALA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SWETHA
Other - Middle Name:
Other - Last Name:DUGGIRALA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:954 52ND ST SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-6004
Mailing Address - Country:US
Mailing Address - Phone:616-724-1780
Mailing Address - Fax:
Practice Address - Street 1:954 52ND ST SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508
Practice Address - Country:US
Practice Address - Phone:616-724-1780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027628122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist