Healthcare Provider Details

I. General information

NPI: 1770918609
Provider Name (Legal Business Name): PRASANNA SAIREDDY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 WASHINGTON AVE STE D
NUTLEY NJ
07110-1956
US

IV. Provider business mailing address

19 FAIRVIEW PL
MONTCLAIR NJ
07043-2318
US

V. Phone/Fax

Practice location:
  • Phone: 973-667-1567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02551200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: