Suvidha Reddy Polu, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

16582 Issued in MD

Practice address

8918 Woodyard Rd
Clinton, MD 20735-4204

Phone

(301) 856-1122

NPI assigned

May 12, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Audubon Dental Center of Clinton

  • General Practice Dentistry
  • Clinton, MD
  • NPI 1497393219
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1494547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584576000000",
    "number": "1114454840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8918 WOODYARD RD",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207354204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8918 WOODYARD RD",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207354204",
            "telephone_number": "301-856-1122"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4422 3rd Ave",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104572545",
            "country_code": "US",
            "telephone_number": "718-618-8011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLU",
        "first_name": "SUVIDHA",
        "middle_name": "REDDY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-12",
        "last_updated": "2020-03-19",
        "certification_date": "2020-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "16582",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pineview Extended Care Centre, Inc.
• Pineview Extended Care Centre, Inc.
• Pinnacle Enrichment Healthcare Services, LLC
• Robin Platt, LGPC
• Ivanna Plymouth, NP
• Nakita Porter
• Neil Pothraj, MD
• Tina Marie Potmesil, LPTA
• Potomac Allergy & Asthma P.C.
• Chiquita Powell Petithomme

• General Practice Dentistry in Clinton, MD
• Providers in Clinton, MD by specialty
• General Practice Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.