Provider Demographics
NPI:1356477301
Name:REDDY, RAGHURAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAGHURAM
Middle Name:
Last Name:REDDY
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 1:9 WOODS WAY
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1270
Mailing Address - Country:US
Mailing Address - Phone:508-660-5900
Mailing Address - Fax:508-668-4766
Practice Address - Street 1:1 RESEARCH DR STE 120C
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-3988
Practice Address - Country:US
Practice Address - Phone:508-660-5900
Practice Address - Fax:508-668-4766
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA116761223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health