Healthcare Provider Details

I. General information

NPI: 1851208896
Provider Name (Legal Business Name): SAIUTH REDDY MALPEDDI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 W HOOSIER BLVD # 102
PERU IN
46970-3727
US

IV. Provider business mailing address

1445 W HOOSIER BLVD # 102
PERU IN
46970-3727
US

V. Phone/Fax

Practice location:
  • Phone: 765-689-8888
  • Fax:
Mailing address:
  • Phone: 765-689-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12015116A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: