MEDICARE: AKHIL REDDY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	24176	TX

General Provider Information

NPI Number	:	1053576447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AKHIL REDDY DDS

Provider Business Mailing Address
First Line	:	3879 IRVING MALL # K-2A
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-5159
Country	:	US
Telephone Number	:	214-574-4867
Fax Number	:

Provider Business Practice Location Address
First Line	:	3879 IRVING MALL # K-2A
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-5159
Country	:	US
Telephone Number	:	214-574-4867
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	07/24/2008

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Directions to “ AKHIL REDDY DDS” Practice Location

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