Provider Demographics
NPI:1356445043
Name:REDDY, SAILAJA G (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAILAJA
Middle Name:G
Last Name:REDDY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4717 REMMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321
Mailing Address - Country:US
Mailing Address - Phone:330-665-4405
Mailing Address - Fax:
Practice Address - Street 1:63 GRAHAM RD
Practice Address - Street 2:STE 3
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1204
Practice Address - Country:US
Practice Address - Phone:330-920-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH217351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2424675Medicaid