Provider Demographics
NPI:1912074717
Name:REDDY, SUHASINI (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUHASINI
Middle Name:
Last Name:REDDY
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 1:11718 DANDY PARK CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-7508
Mailing Address - Country:US
Mailing Address - Phone:713-500-8220
Mailing Address - Fax:
Practice Address - Street 1:6655 TRAVIS ST STE 460
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1316
Practice Address - Country:US
Practice Address - Phone:713-500-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0126511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000969614BMedicaid