Healthcare Provider Details

I. General information

NPI: 1093693715
Provider Name (Legal Business Name): KAMREDDY DENTAL ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10684 CRESTWOOD DR STE C
MANASSAS VA
20109-4400
US

IV. Provider business mailing address

10684 CRESTWOOD DR STE C
MANASSAS VA
20109-4400
US

V. Phone/Fax

Practice location:
  • Phone: 703-361-6866
  • Fax:
Mailing address:
  • Phone: 703-361-6866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KEERTHI REDDY KAMREDDY
Title or Position: DENTIST
Credential: DDS
Phone: 913-832-5870