Provider Demographics
NPI:1407236706
Name:KRISHNA M REDDY DDS INC
Entity Type:Organization
Organization Name:KRISHNA M REDDY DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-699-0343
Mailing Address - Street 1:7910 NORWALK BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-2196
Mailing Address - Country:US
Mailing Address - Phone:562-699-0343
Mailing Address - Fax:562-699-1609
Practice Address - Street 1:7910 NORWALK BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-2196
Practice Address - Country:US
Practice Address - Phone:562-699-0343
Practice Address - Fax:562-699-1609
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR KRISHNA M REDDY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-02
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30106122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB30106-02Medicaid