Provider Demographics
NPI:1619127065
Name:REDDY, DEEPIKA M (DDS)
Entity Type:Individual
Prefix:
First Name:DEEPIKA
Middle Name:M
Last Name:REDDY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DEEPIKA
Other - Middle Name:REDDY
Other - Last Name:MAHASAMUDRAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2314 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002
Mailing Address - Country:US
Mailing Address - Phone:856-667-3737
Mailing Address - Fax:856-667-3758
Practice Address - Street 1:2314 CHURCH RD
Practice Address - Street 2:CHERRY HILL DENTAL SMILES
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002
Practice Address - Country:US
Practice Address - Phone:856-667-3737
Practice Address - Fax:856-667-3758
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02386000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty