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Provider Information for 1851631568



DR. RAMDEEPAK NANAMALA REDDY D.D.S.

Other Name:   DEEPAK REDDY
Gender: MALE

Individual NPI: 1851631568

Calendar   Last Updated:  2013-02-18
  Certification Date: 

Details

Name Value
NPI 1851631568
Enumeration Date 2013-02-18
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 13999 HICKCOX LN
RANCHO CUCAMONGA, CA 91739-2228
United States

Phone: 760-402-0529 | Fax:
View Map External Link
Primary Practice Address 14495 7TH ST STE A
VICTORVILLE, CA 92395-4233
United States

Phone: 760-245-7800 | 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 CA 62102