Provider Demographics
NPI:1114578192
Name:KAMREDDY, KEERTHI REDDY (MS IN PERIODONTOLOG)
Entity Type:Individual
Prefix:DR
First Name:KEERTHI REDDY
Middle Name:
Last Name:KAMREDDY
Suffix:
Gender:F
Credentials:MS IN PERIODONTOLOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22480 TERRA ROSA PL
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-7350
Mailing Address - Country:US
Mailing Address - Phone:913-832-5870
Mailing Address - Fax:
Practice Address - Street 1:9097 ATLEE STATION RD STE 120
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2525
Practice Address - Country:US
Practice Address - Phone:804-270-5214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-22
Last Update Date:2019-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014166921223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty