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Provider Information for 1063860302

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. VISHNU VARDHAN-REDDY BURLA D.D.S.

Gender: MALE

Individual NPI: 1063860302

Calendar   Last Updated:  2016-05-26
  Certification Date: 

Details

Name Value
NPI 1063860302
Enumeration Date 2016-05-26
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 3760 S DORT HWY
FLINT, MI 48507-2045
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 3760 S DORT HWY
FLINT, MI 48507-2045
United States

Phone: 810-820-7766 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist MI 2901021894