Provider Demographics
NPI:1689924953
Name:VASIREDDY, DEEPTHI (DMD)
Entity Type:Individual
Prefix:
First Name:DEEPTHI
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 1:97 W MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-2327
Mailing Address - Country:US
Mailing Address - Phone:603-669-8678
Mailing Address - Fax:
Practice Address - Street 1:97 W MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-2327
Practice Address - Country:US
Practice Address - Phone:603-669-8678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856126122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist