Provider Demographics
NPI:1447425392
Name:RAJU REDDY DDS,MD,INC.
Entity Type:Organization
Organization Name:RAJU REDDY DDS,MD,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJU
Authorized Official - Middle Name:YEDDULA
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MD
Authorized Official - Phone:650-387-6517
Mailing Address - Street 1:11 BIRCH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1480
Mailing Address - Country:US
Mailing Address - Phone:650-387-6517
Mailing Address - Fax:650-362-1980
Practice Address - Street 1:11 BIRCH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1480
Practice Address - Country:US
Practice Address - Phone:650-387-6517
Practice Address - Fax:650-362-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOMS46261QS0112X
CAA80394261QS0112X
CAGA 1293261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery