Provider Demographics
NPI:1043445943
Name:SANDADI, GIRISH REDDY (DDS)
Entity Type:Individual
Prefix:MR
First Name:GIRISH
Middle Name:REDDY
Last Name:SANDADI
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 1:415 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-5518
Mailing Address - Country:US
Mailing Address - Phone:361-664-0145
Mailing Address - Fax:361-664-2248
Practice Address - Street 1:415 S 6TH ST
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-5518
Practice Address - Country:US
Practice Address - Phone:361-664-0145
Practice Address - Fax:361-664-2248
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24535122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist