Individual
DR. NITYA REDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
520 N 12TH ST, RICHMOND, VA 23298-5064
(804) 828-9356
Mailing address
520 N 12TH ST, RICHMOND, VA 23298-5064
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
0442000368
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0442000368
TEMPORARY RESIDENT DENTAL LICENSE IN VA
VA
Enumeration date
06/19/2017
Last updated
10/03/2019
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