Provider Demographics
NPI:1396589743
Name:DERE, SUVIDHA (DDS)
Entity type:Individual
Prefix:
First Name:SUVIDHA
Middle Name:
Last Name:DERE
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 1:365 UPTOWN BLVD APT 13302
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3574
Mailing Address - Country:US
Mailing Address - Phone:734-680-4740
Mailing Address - Fax:
Practice Address - Street 1:105 E BELT LINE RD STE 900
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2230
Practice Address - Country:US
Practice Address - Phone:469-454-3054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40513122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist