Provider Demographics
NPI:1407883242
Name:REDDY, RICHARD WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WILLIAM
Last Name:REDDY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MOHRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19541-8872
Mailing Address - Country:US
Mailing Address - Phone:610-926-3600
Mailing Address - Fax:610-926-5500
Practice Address - Street 1:805 N RICHMOND ST
Practice Address - Street 2:SUITE 102
Practice Address - City:FLEETWOOD
Practice Address - State:PA
Practice Address - Zip Code:19522-1031
Practice Address - Country:US
Practice Address - Phone:610-944-9771
Practice Address - Fax:610-944-0702
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-019558-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice