Provider Demographics
NPI:1861456253
Name:AMMANA, PRAMIDA REDDY (DMD)
Entity Type:Individual
Prefix:
First Name:PRAMIDA
Middle Name:REDDY
Last Name:AMMANA
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 1:55 SHILLING RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-4311
Mailing Address - Country:US
Mailing Address - Phone:732-216-4830
Mailing Address - Fax:
Practice Address - Street 1:55 SHILLING RD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-4311
Practice Address - Country:US
Practice Address - Phone:732-216-4830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0229011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice