Provider Demographics
NPI:1356536338
Name:REDDY DENTAL DBA PA
Entity type:Organization
Organization Name:REDDY DENTAL DBA PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NUKALA
Authorized Official - Middle Name:H
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-493-5555
Mailing Address - Street 1:13618 NW MILITARY HWY
Mailing Address - Street 2:
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1804
Mailing Address - Country:US
Mailing Address - Phone:210-493-5555
Mailing Address - Fax:210-493-5561
Practice Address - Street 1:13618 NW MILITARY HWY
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78231-1804
Practice Address - Country:US
Practice Address - Phone:210-493-5555
Practice Address - Fax:210-493-5561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22740261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental