Healthcare Provider Details

I. General information

NPI: 1346529559
Provider Name (Legal Business Name): UJVAL REDDY GUMMI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3D DENTAL BATTALION/USNDC OKINAWA UNIT 38450
FPO AP
96604
US

IV. Provider business mailing address

3D DENTAL BATTALION/USNDC OKINAWA UNIT 38450
FPO AP
96604
US

V. Phone/Fax

Practice location:
  • Phone: 315-645-2390
  • Fax:
Mailing address:
  • Phone: 315-645-2390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number60613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: