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General NPI Number Information
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NPI Number | 1982170809
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Entity Type | Individual
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Provider Name | NAVEEN KUMAR REDDY ADMALA DMD
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Gender | Male
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Dates
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Enumeration Date | 10/18/2018
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 2180 NORTHPOINT PKWY
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City | SANTA ROSA
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State | CA
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Zip | 95407-7395
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Country | US
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Telephone | 707-354-6845
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Fax |
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Provider Business Mailing Address
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Address Line | 386 CASCADES CT
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City | MORGAN HILL
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State | CA
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Zip | 95037-5369
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Country | US
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Telephone | 857-272-0990
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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 | DN1858153
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 107819
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License Number State | CA
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