Provider Demographics
NPI:1982170809
Name:ADMALA, NAVEEN KUMAR REDDY (DMD)
Entity Type:Individual
Prefix:
First Name:NAVEEN
Middle Name:KUMAR REDDY
Last Name:ADMALA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 CASCADES CT
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-5369
Mailing Address - Country:US
Mailing Address - Phone:857-272-0990
Mailing Address - Fax:
Practice Address - Street 1:2180 NORTHPOINT PKWY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-7395
Practice Address - Country:US
Practice Address - Phone:707-354-6845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18581531223G0001X
CA1078191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice