Provider Demographics
NPI:1063860302
Name:BURLA, VISHNU VARDHAN-REDDY (DDS)
Entity Type:Individual
Prefix:DR
First Name:VISHNU
Middle Name:VARDHAN-REDDY
Last Name:BURLA
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 1:33200 W 14 MILE RD STE 190
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3570
Mailing Address - Country:US
Mailing Address - Phone:248-847-3828
Mailing Address - Fax:248-847-3829
Practice Address - Street 1:33200 W 14 MILE RD STE 190
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3570
Practice Address - Country:US
Practice Address - Phone:248-847-3828
Practice Address - Fax:248-847-3829
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021894122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist