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General NPI Number Information
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NPI Number | 1962719344
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Entity Type | Individual
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Provider Name | SWAPNA REDDY KETHI REDDY
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Gender | Female
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Dates
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Enumeration Date | 09/08/2010
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Last Update Date | 04/10/2014
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Provider Practice Location Address
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Address Line | 1614 E BELT LINE RD
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City | CARROLLTON
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State | TX
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Zip | 75006-6309
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Country | US
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Telephone | 972-466-0077
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Fax |
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Provider Business Mailing Address
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Address Line | 280 W RENNER RD #2723
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City | RICHARDSON
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State | TX
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Zip | 75080-1349
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Country | US
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Telephone | 214-563-3009
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0025940
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License Number State | TX
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