Provider Demographics
NPI:1679123566
Name:REDDY, SUDHA ANAND (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUDHA
Middle Name:ANAND
Last Name:REDDY
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 1:100 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-1195
Mailing Address - Country:US
Mailing Address - Phone:309-755-4511
Mailing Address - Fax:
Practice Address - Street 1:100 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-1195
Practice Address - Country:US
Practice Address - Phone:309-755-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.023354122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist