Provider Demographics
NPI:1851631568
Name:REDDY, RAMDEEPAK NANAMALA (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAMDEEPAK
Middle Name:NANAMALA
Last Name:REDDY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DEEPAK
Other - Middle Name:NANAMALA
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:40140 WINCHESTER RD STE A
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-6517
Mailing Address - Country:US
Mailing Address - Phone:951-695-1870
Mailing Address - Fax:
Practice Address - Street 1:40140 WINCHESTER RD STE A
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6517
Practice Address - Country:US
Practice Address - Phone:951-695-1870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62102122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist