Provider Demographics
NPI:1265506521
Name:VASIREDDY, KISHORE K (DMS)
Entity Type:Individual
Prefix:DR
First Name:KISHORE
Middle Name:K
Last Name:VASIREDDY
Suffix:
Gender:M
Credentials:DMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6140 PARKLAND BLVD SUITE 100
Mailing Address - Street 2:AMERICAN DENTAL CENTER
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:440-446-1555
Mailing Address - Fax:440-446-1999
Practice Address - Street 1:4957 W TUSCARAWAS
Practice Address - Street 2:AMERICAN DENTAL CENTER
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708
Practice Address - Country:US
Practice Address - Phone:330-478-5111
Practice Address - Fax:330-479-0518
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH186511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice