Provider Demographics
NPI:1316389604
Name:NALLA, VENKATA RAMANA REDDY
Entity Type:Individual
Prefix:
First Name:VENKATA RAMANA REDDY
Middle Name:
Last Name:NALLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8229 RANCHVIEW DR
Mailing Address - Street 2:APT#1043
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7688
Mailing Address - Country:US
Mailing Address - Phone:770-778-3848
Mailing Address - Fax:
Practice Address - Street 1:2903 50TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-4323
Practice Address - Country:US
Practice Address - Phone:806-589-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD3929122300000X
TX29422122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist