Provider Demographics
NPI:1760752869
Name:REDDY PEDIATRIC DENTISTRY, P.C.
Entity Type:Organization
Organization Name:REDDY PEDIATRIC DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-213-8966
Mailing Address - Street 1:274 SOUTH COLLINS ROAD
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182
Mailing Address - Country:US
Mailing Address - Phone:972-329-5437
Mailing Address - Fax:972-329-5436
Practice Address - Street 1:274 SOUTH COLLINS ROAD
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182
Practice Address - Country:US
Practice Address - Phone:972-329-5437
Practice Address - Fax:972-329-5436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0095184-01Medicaid