Provider Demographics
NPI:1407380207
Name:NIRUP REDDY AND BORTAY DEHNADI D.D.S, INC.
Entity Type:Organization
Organization Name:NIRUP REDDY AND BORTAY DEHNADI D.D.S, INC.
Other - Org Name:NIRUP REDDY AND BORTAY DEHNADI D.D.S, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NIRUP
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-398-5555
Mailing Address - Street 1:1507 PANAMA LN STE 102
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-5682
Mailing Address - Country:US
Mailing Address - Phone:661-398-5555
Mailing Address - Fax:661-398-5510
Practice Address - Street 1:1507 PANAMA LN STE 102
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-5682
Practice Address - Country:US
Practice Address - Phone:661-398-5555
Practice Address - Fax:661-398-5510
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HACIENDA DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1487027843Medicaid