Provider Demographics
NPI:1831277003
Name:REDDY, SAVITHA (DMD)
Entity type:Individual
Prefix:DR
First Name:SAVITHA
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SAVITHA
Other - Middle Name:REDDY
Other - Last Name:KAMBAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:21 CARMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1137
Mailing Address - Country:US
Mailing Address - Phone:516-794-3301
Mailing Address - Fax:
Practice Address - Street 1:729 ELMONT RD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4035
Practice Address - Country:US
Practice Address - Phone:516-285-2000
Practice Address - Fax:516-285-2000
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046903-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01732732Medicaid