Provider Demographics
NPI:1346529559
Name:GUMMI, UJVAL REDDY (DMD)
Entity Type:Individual
Prefix:DR
First Name:UJVAL
Middle Name:REDDY
Last Name:GUMMI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3D DENTAL BATTALION/USNDC OKINAWA
Mailing Address - Street 2:UNIT 38450
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96604
Mailing Address - Country:US
Mailing Address - Phone:315-645-2390
Mailing Address - Fax:
Practice Address - Street 1:3D DENTAL BATTALION/USNDC OKINAWA
Practice Address - Street 2:UNIT 38450
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96604
Practice Address - Country:US
Practice Address - Phone:315-645-2390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60613122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist