Provider Demographics
NPI:1740647999
Name:VALLAMREDDY, PRANEETHA (DDS)
Entity type:Individual
Prefix:DR
First Name:PRANEETHA
Middle Name:
Last Name:VALLAMREDDY
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 1:13883 E RICHTHOFEN CIR APT H106
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-6775
Mailing Address - Country:US
Mailing Address - Phone:859-494-3980
Mailing Address - Fax:
Practice Address - Street 1:181 W BUSINESS 190
Practice Address - Street 2:SUITE 4
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-3671
Practice Address - Country:US
Practice Address - Phone:245-987-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX316431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice