Provider Demographics
NPI:1528427812
Name:GUDHIMELLA, LAKSHMI SUDHA (BDS, MS, MBA)
Entity type:Individual
Prefix:
First Name:LAKSHMI SUDHA
Middle Name:
Last Name:GUDHIMELLA
Suffix:
Gender:F
Credentials:BDS, MS, MBA
Other - Prefix:DR
Other - First Name:SUDHA
Other - Middle Name:
Other - Last Name:GUDHIMELLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BDS, MS
Mailing Address - Street 1:401 E CHESTNUT ST UNIT 550
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-5705
Mailing Address - Country:US
Mailing Address - Phone:502-852-2621
Mailing Address - Fax:
Practice Address - Street 1:501 S PRESTON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40292-7001
Practice Address - Country:US
Practice Address - Phone:502-852-2621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100271223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics