Provider Demographics
NPI:1811154289
Name:RAINA, DIVYA REDDY (DDS)
Entity type:Individual
Prefix:DR
First Name:DIVYA
Middle Name:REDDY
Last Name:RAINA
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 1:4390 PLEASANT HILL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8054
Mailing Address - Country:US
Mailing Address - Phone:770-622-9772
Mailing Address - Fax:770-622-6446
Practice Address - Street 1:4390 PLEASANT HILL RD
Practice Address - Street 2:SUITE A
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8054
Practice Address - Country:US
Practice Address - Phone:770-622-9772
Practice Address - Fax:770-622-6446
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011742122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist