Provider Demographics
NPI:1649455361
Name:REDDY, BANGALORE T SHARAT C (DDS)
Entity type:Individual
Prefix:DR
First Name:BANGALORE T SHARAT
Middle Name:C
Last Name:REDDY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:SHARAT
Other - Middle Name:C
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3103 76TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1822
Mailing Address - Country:US
Mailing Address - Phone:718-899-6696
Mailing Address - Fax:
Practice Address - Street 1:3103 76TH ST
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1822
Practice Address - Country:US
Practice Address - Phone:718-899-6696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042290122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist