Organization
DIVYA PEDDIREDDY DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIVYA PEDDIREDDY (SOLE OWNER)
(562) 650-8076
Entity
Organization
Contact information
Practice address
3070 BRISTOL ST STE 180, COSTA MESA, CA 92626-3072
(714) 924-4824
Mailing address
3070 BRISTOL ST STE 180, COSTA MESA, CA 92626-3072
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/13/2024
Last updated
02/13/2024
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