Provider Demographics
NPI:1659005379
Name:VASIREDDY, SIRISHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SIRISHA
Middle Name:
Last Name:VASIREDDY
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 1:2342 CARRINGTON ST NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-8182
Mailing Address - Country:US
Mailing Address - Phone:330-280-4912
Mailing Address - Fax:
Practice Address - Street 1:2525 W CAREFREE HWY STE 154
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-9305
Practice Address - Country:US
Practice Address - Phone:623-533-5699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0115031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice