Healthcare Provider Details

I. General information

NPI: 1508317124
Provider Name (Legal Business Name): SILPA BHIMIREDDY D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W MCMILLAN ST
MARSHFIELD WI
54449-6013
US

IV. Provider business mailing address

813 MONIQUE LN
MARSHFIELD WI
54449-2445
US

V. Phone/Fax

Practice location:
  • Phone: 715-387-1702
  • Fax: 715-384-7915
Mailing address:
  • Phone: 646-323-3586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1001235
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: