Healthcare Provider Details

I. General information

NPI: 1699691634
Provider Name (Legal Business Name): SARANYA DEVATHA MALLAREDDY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E SOUTH BOUNDARY ST
PERRYSBURG OH
43551-2527
US

IV. Provider business mailing address

1309 MULBERRY OAK LN
GEORGETOWN TX
78628-3756
US

V. Phone/Fax

Practice location:
  • Phone: 419-792-1264
  • Fax:
Mailing address:
  • Phone: 437-989-4329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.028572
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: