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General NPI Number Information
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NPI Number | 1760020291
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Entity Type | Organization
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Legal Business Name | REDDY DENTAL PC
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Dates
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Enumeration Date | 12/16/2019
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 68 THOMAS JOHNSON DR STE B
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City | FREDERICK
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State | MD
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Zip | 21702-4901
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Country | US
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Telephone | 301-620-9090
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Fax |
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Provider Business Mailing Address
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Address Line | 8415 DATAPOINT DR STE 1020
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3277
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Country | US
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Telephone | 714-578-6591
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR
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Name | BEATRIZ HERNANDEZ
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Credential |
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Telephone | 714-578-6591
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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 |
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License Number State |
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