Provider Demographics
NPI:1205066891
Name:KYATAM, VAMSHIDER REDDY (DMD)
Entity type:Individual
Prefix:DR
First Name:VAMSHIDER
Middle Name:REDDY
Last Name:KYATAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:KYATAM
Other - Middle Name:
Other - Last Name:VAMSHIDER REDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26919 US HIGHWAY 380 E UNIT 216
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-7804
Mailing Address - Country:US
Mailing Address - Phone:940-213-3752
Mailing Address - Fax:940-213-3763
Practice Address - Street 1:26919 US HIGHWAY 380 E UNIT 216
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-7804
Practice Address - Country:US
Practice Address - Phone:903-813-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24768122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist