Provider Demographics
NPI:1407965254
Name:REDDY, RADHA IDURU (DMD)
Entity Type:Individual
Prefix:DR
First Name:RADHA
Middle Name:IDURU
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 1:84 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-5935
Mailing Address - Country:US
Mailing Address - Phone:508-993-9947
Mailing Address - Fax:508-993-1058
Practice Address - Street 1:84 SPRING ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-5935
Practice Address - Country:US
Practice Address - Phone:508-993-9947
Practice Address - Fax:508-993-1058
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA197691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice