Provider Demographics
NPI:1316025588
Name:REDDY, CHIRAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHIRAN
Middle Name:
Last Name:REDDY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:CHIRANJEEV
Other - Middle Name:KAMBAM
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:21 CARMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:257-08 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PK
Practice Address - State:NY
Practice Address - Zip Code:11004
Practice Address - Country:US
Practice Address - Phone:718-470-0500
Practice Address - Fax:718-347-2747
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043672-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01452611Medicare ID - Type Unspecified