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General NPI Number Information
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NPI Number | 1104591023
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Entity Type | Individual
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Provider Name | DESTINY REDDING DMD
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Gender | Female
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Dates
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Enumeration Date | 08/12/2021
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Last Update Date | 02/27/2023
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Provider Practice Location Address
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Address Line | 1430 HIGHWAY 20 W
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City | MCDONOUGH
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State | GA
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Zip | 30253-7305
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Country | US
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Telephone | 678-537-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 712 STRATTON DR
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City | MCDONOUGH
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State | GA
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Zip | 30253-8048
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Country | US
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Telephone | 770-895-2864
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12455
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN122370
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License Number State | GA
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