Provider Demographics
NPI:1023243375
Name:GUTTA, ARCHANA (DDS)
Entity type:Individual
Prefix:
First Name:ARCHANA
Middle Name:
Last Name:GUTTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ARCHANA
Other - Middle Name:
Other - Last Name:VADLAMUDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS; MPH
Mailing Address - Street 1:3306 ANDREWS HWY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-5131
Mailing Address - Country:US
Mailing Address - Phone:432-553-6133
Mailing Address - Fax:
Practice Address - Street 1:3306 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-5131
Practice Address - Country:US
Practice Address - Phone:432-553-6133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245611223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202112310Medicaid