Provider Demographics
NPI:1427139682
Name:DUSANAPUDI, SUDHA N (DDS, MMSC)
Entity type:Individual
Prefix:DR
First Name:SUDHA
Middle Name:N
Last Name:DUSANAPUDI
Suffix:
Gender:F
Credentials:DDS, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 HILDEBRAND CIR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6301
Mailing Address - Country:US
Mailing Address - Phone:916-367-9044
Mailing Address - Fax:916-735-2407
Practice Address - Street 1:562 HILDEBRAND CIR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6301
Practice Address - Country:US
Practice Address - Phone:916-367-9044
Practice Address - Fax:916-735-2407
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics