Provider Demographics
NPI:1043411457
Name:REDDY, HARI K (DDS)
Entity Type:Individual
Prefix:
First Name:HARI
Middle Name:K
Last Name:REDDY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90270-0027
Mailing Address - Country:US
Mailing Address - Phone:323-773-0855
Mailing Address - Fax:323-773-0043
Practice Address - Street 1:4428 SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270-2932
Practice Address - Country:US
Practice Address - Phone:323-773-0855
Practice Address - Fax:323-773-0043
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD29428122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist