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NPI Code Detail

MEDICARE: DR. DEBRA M REDDICK D.D.S

MEDICARE: DR. DEBRA M REDDICK D.D.S
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
11223D0001XPublic Health DentistryDN013060GA
21223G0001XGeneral Practice DentistryDN013060GA
31223G0001XGeneral Practice DentistryDN013060GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396710901
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEBRA M REDDICK D.D.S
Provider Business Mailing Address
First Line : 400 PLAYERS CT
Second Line :
City : MCDONOUGH
State : GA
Zip : 30253-8810
Country : US
Telephone Number : 908-285-6051
Fax Number :
Provider Business Practice Location Address
First Line : 4458 JONESBORO RD
Second Line :
City : FOREST PARK
State : GA
Zip : 30297-4314
Country : US
Telephone Number : 470-878-3512
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2006
Last Update Date : 07/21/2021

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