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General NPI Number Information
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NPI Number | 1770224107
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Entity Type | Organization
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Legal Business Name | SWETHA REDDY & PAVAN KANCHARLA LLC
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Dates
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Enumeration Date | 04/07/2022
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 190 MALABAR RD. SUITE 104
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City | PALM BAY
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State | FL
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Zip | 32907
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Country | US
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Telephone | 321-914-0080
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Fax | 321-241-3002
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Provider Business Mailing Address
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Address Line | 190 MALABAR RD SW STE 104
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City | PALM BAY
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State | FL
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Zip | 32907-2975
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Country | US
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Telephone | 321-576-4825
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Fax | 321-241-3002
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Authorized Official
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Title or Position | OWNER
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Name | SWETHA G REDDY
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Credential | DMD
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Telephone | 321-914-0080
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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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