Provider Demographics
NPI:1427242114
Name:SADDI, SUPRIYA AYYALAPU (DDS)
Entity type:Individual
Prefix:DR
First Name:SUPRIYA
Middle Name:AYYALAPU
Last Name:SADDI
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 1:2510 AMANTEA WAY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-7343
Mailing Address - Country:US
Mailing Address - Phone:707-758-3098
Mailing Address - Fax:
Practice Address - Street 1:2510 AMANTEA WAY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-7343
Practice Address - Country:US
Practice Address - Phone:707-758-3098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56257122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist