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General NPI Number Information
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NPI Number | 1184024291
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Entity Type | Individual
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Provider Name | CANDACE M REDDICK DDS
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Gender | Female
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Dates
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Enumeration Date | 08/26/2014
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 620 S. JAMES CAMPBELL BLVD
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City | COLUMBIA
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State | TN
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Zip | 38401
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Country | US
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Telephone | 931-952-6389
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Fax |
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Provider Business Mailing Address
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Address Line | 620 S. JAMES CAMPBELL BLVD
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City | COLUMBIA
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State | TN
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Zip | 38401
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Country | US
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Telephone | 931-614-0983
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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 | DN1856949
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License Number State | MA
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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 | DN20901
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6711
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License Number State | LA
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