Provider Demographics
NPI:1003939489
Name:REDDY, ANITHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANITHA
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6826 FINAMORE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-8726
Mailing Address - Country:US
Mailing Address - Phone:561-965-1254
Mailing Address - Fax:561-965-1810
Practice Address - Street 1:5700 LAKE WORTH RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-4727
Practice Address - Country:US
Practice Address - Phone:561-965-1254
Practice Address - Fax:561-965-1810
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 160531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice