Individual
SUDHA BYREDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3525 BUSBEE DR NW, KENNESAW, GA 30144-5677
(404) 771-5345
Mailing address
3525 BUSBEE DR NW, KENNESAW, GA 30144-5677
(404) 771-5345
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN122815
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NON MEDICARE
GA
Enumeration date
07/29/2022
Last updated
07/29/2022
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