Provider Demographics
NPI:1730675349
Name:REDDY SABALAM, JYOTHSNA (DMD)
Entity Type:Individual
Prefix:
First Name:JYOTHSNA
Middle Name:
Last Name:REDDY SABALAM
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 1:600 MOON CIR UNIT 626
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4127
Mailing Address - Country:US
Mailing Address - Phone:857-472-9026
Mailing Address - Fax:
Practice Address - Street 1:825 E BIDWELL ST STE 400
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4207
Practice Address - Country:US
Practice Address - Phone:916-984-4591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102693122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist