Provider Demographics
NPI:1578731568
Name:GADDAM, DEEPA REDDY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEEPA
Middle Name:REDDY
Last Name:GADDAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ALBURY WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-4201
Mailing Address - Country:US
Mailing Address - Phone:908-307-0346
Mailing Address - Fax:
Practice Address - Street 1:6901 MCCART AVE STE 175
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-6373
Practice Address - Country:US
Practice Address - Phone:817-263-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX236681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice