Provider Demographics
NPI:1811620222
Name:INDURI, SRI NITYA REDDY REDDY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SRI NITYA REDDY
Middle Name:REDDY
Last Name:INDURI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 FERRY LANDING LN NW UNIT 2402
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1664
Mailing Address - Country:US
Mailing Address - Phone:425-503-3690
Mailing Address - Fax:
Practice Address - Street 1:3365 PIEDMONT RD NE STE 1110
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1708
Practice Address - Country:US
Practice Address - Phone:404-382-8310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122801122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes122300000XDental ProvidersDentist