Provider Demographics
NPI:1669656401
Name:REDDY, SWATHI R (DDS)
Entity Type:Individual
Prefix:DR
First Name:SWATHI
Middle Name:R
Last Name:REDDY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SWATHI
Other - Middle Name:R
Other - Last Name:KUPPAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:9010 LORTON STATION BLVD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-4792
Mailing Address - Country:US
Mailing Address - Phone:703-337-4414
Mailing Address - Fax:703-337-4495
Practice Address - Street 1:9010 LORTON STATION BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4792
Practice Address - Country:US
Practice Address - Phone:703-337-4414
Practice Address - Fax:703-337-4495
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD142831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics