Provider Demographics
NPI:1548779572
Name:DEEPA REDDY, DMD, PLLC
Entity Type:Organization
Organization Name:DEEPA REDDY, DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEEPA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-332-5429
Mailing Address - Street 1:74 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-2708
Mailing Address - Country:US
Mailing Address - Phone:603-332-5429
Mailing Address - Fax:603-332-6641
Practice Address - Street 1:74 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-2708
Practice Address - Country:US
Practice Address - Phone:603-332-5429
Practice Address - Fax:603-332-6641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03784122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH03784OtherLICENSE