Provider Demographics
NPI:1922480367
Name:NAGARIMADUGU, REDDI SUMATHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:REDDI SUMATHI
Middle Name:
Last Name:NAGARIMADUGU
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 1:4345 CHANTICLEER DR
Mailing Address - Street 2:APT # B6
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229
Mailing Address - Country:US
Mailing Address - Phone:503-336-3004
Mailing Address - Fax:
Practice Address - Street 1:2235 NW TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97006
Practice Address - Country:US
Practice Address - Phone:503-825-8862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD103171223G0001X
WADE605768011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice