Provider Demographics
NPI:1487027843
Name:NIRUP REDDY AND BORTAY DEHNADI DDS, INC.
Entity Type:Organization
Organization Name:NIRUP REDDY AND BORTAY DEHNADI DDS, INC.
Other - Org Name:REDDY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIRUP
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-973-1919
Mailing Address - Street 1:251 W HARVARD BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-3213
Mailing Address - Country:US
Mailing Address - Phone:310-973-1919
Mailing Address - Fax:310-679-7777
Practice Address - Street 1:4570 W EL SEGUNDO BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-4318
Practice Address - Country:US
Practice Address - Phone:310-973-1919
Practice Address - Fax:310-679-7777
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NIRUP REDDY AND BORTAY DEHNADI DDS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-07
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50800122300000X
CA56334122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty