Provider Demographics
NPI:1730301417
Name:REDDY, NAGAREKHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NAGAREKHA
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:NAGAREKHA
Other - Middle Name:REDDY
Other - Last Name:GUMMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:17255 MONACO DR
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703
Mailing Address - Country:US
Mailing Address - Phone:562-402-8591
Mailing Address - Fax:
Practice Address - Street 1:1601N LONG BEACH BLVD.
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221
Practice Address - Country:US
Practice Address - Phone:310-639-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice