Provider Demographics
NPI:1427569870
Name:ANUGU, DIVYA REDDY (DMD)
Entity Type:Individual
Prefix:DR
First Name:DIVYA
Middle Name:REDDY
Last Name:ANUGU
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 1:1 STONE LN APT 2301
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-1566
Mailing Address - Country:US
Mailing Address - Phone:973-704-9476
Mailing Address - Fax:
Practice Address - Street 1:35 PLEASANT ST STE 2D
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-7596
Practice Address - Country:US
Practice Address - Phone:203-404-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT129731223G0001X
MADN18577881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice