Provider Demographics
NPI:1700769601
Name:RIVERDALE DENTAL SMILES
Entity type:Organization
Organization Name:RIVERDALE DENTAL SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GUDIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-966-7766
Mailing Address - Street 1:6650 HIGHWAY 85
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2382
Mailing Address - Country:US
Mailing Address - Phone:770-997-6222
Mailing Address - Fax:
Practice Address - Street 1:6650 HIGHWAY 85
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2382
Practice Address - Country:US
Practice Address - Phone:770-997-6222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental