Provider Demographics
NPI:1790523140
Name:GADDE, DEEPA SREE
Entity type:Individual
Prefix:
First Name:DEEPA
Middle Name:SREE
Last Name:GADDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 EASTON RD STE 9
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-2024
Mailing Address - Country:US
Mailing Address - Phone:215-659-3334
Mailing Address - Fax:
Practice Address - Street 1:801 EASTON RD STE 9
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-2024
Practice Address - Country:US
Practice Address - Phone:215-659-3334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS045360122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty