Provider Demographics
NPI:1942660832
Name:HIMA REDDY PC
Entity Type:Organization
Organization Name:HIMA REDDY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HIMA-BINDU
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-578-6358
Mailing Address - Street 1:8415 DATAPOINT DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3298
Mailing Address - Country:US
Mailing Address - Phone:703-823-2413
Mailing Address - Fax:703-823-8271
Practice Address - Street 1:5249 DUKE ST
Practice Address - Street 2:STE. 210
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2926
Practice Address - Country:US
Practice Address - Phone:703-823-2413
Practice Address - Fax:703-823-8271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA401411155122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty