Individual
SUDHA M EDPUGANTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8020 NORTHLAKE CREEK DR STE B, CHARLOTTE, NC 28216-4487
(704) 264-1441
Mailing address
1132 GRAND OAK DR, WAXHAW, NC 28173-0346
(980) 226-8891
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
11112
NC
1223G0001X
General Practice Dentistry
9273
SC
Other
Enumeration date
07/06/2018
Last updated
08/17/2021
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