Provider Demographics
NPI:1689682569
Name:REDDY, ARATHI J (DMD)
Entity Type:Individual
Prefix:MRS
First Name:ARATHI
Middle Name:J
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 1:1021 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-1803
Mailing Address - Country:US
Mailing Address - Phone:402-476-1640
Mailing Address - Fax:402-476-1670
Practice Address - Street 1:1021 N 27TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-1803
Practice Address - Country:US
Practice Address - Phone:402-476-1640
Practice Address - Fax:402-476-1670
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE67361223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025024300Medicaid
NE10025024400Medicaid