Provider Demographics
NPI:1255999108
Name:REDDY, ANJALI MALLA (DDS)
Entity type:Individual
Prefix:DR
First Name:ANJALI
Middle Name:MALLA
Last Name:REDDY
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 1:4140 WOODLANDS PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3501
Mailing Address - Country:US
Mailing Address - Phone:727-789-1980
Mailing Address - Fax:
Practice Address - Street 1:4140 WOODLANDS PKWY STE A
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-3501
Practice Address - Country:US
Practice Address - Phone:727-789-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN28723122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program