Provider Demographics
NPI:1295308492
Name:REDDY, JESSICA (DDS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
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 1:10244 APPLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-5128
Mailing Address - Country:US
Mailing Address - Phone:219-765-8835
Mailing Address - Fax:
Practice Address - Street 1:9486 WICKER AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9400
Practice Address - Country:US
Practice Address - Phone:219-765-8835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261561223D0001X
IL019.0333501223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health