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General NPI Number Information
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NPI Number | 1427102961
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Entity Type | Organization
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Legal Business Name | BLOOM & REDDY DDS PC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 130 THOMAS JOHNSON DRIVE SUITE 2
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City | FREDERICK
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State | MD
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Zip | 21702-4582
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Country | US
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Telephone | 301-631-5860
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Fax | 301-631-5861
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Provider Business Mailing Address
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Address Line | 130 THOMAS JOHNSON DRIVE SUITE 2
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City | FREDERICK
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State | MD
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Zip | 21702-4582
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Country | US
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Telephone | 301-631-5860
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Fax | 301-631-5861
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Authorized Official
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Title or Position | ORTHODONTIST PARTNER
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Name | DR. KAVITHA B REDDY
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Credential | DDS MS
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Telephone | 301-631-5860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 11628
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License Number State | MD
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