Provider Demographics
NPI:1497180269
Name:REDDY, POOJA K (DMD)
Entity Type:Individual
Prefix:
First Name:POOJA
Middle Name:K
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 1:3012 LONG CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5305
Mailing Address - Country:US
Mailing Address - Phone:502-296-9799
Mailing Address - Fax:
Practice Address - Street 1:134 EVERGREEN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1487
Practice Address - Country:US
Practice Address - Phone:502-254-8514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY93301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice