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Individual

DR. VIJAY BHASKAR REDDY GADDAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
1073 RIVERDALE ST, WEST SPRINGFIELD, MA 01089-4614
(413) 285-7114
(413) 285-7168
Mailing address
19 RAILROAD ST, 2B, ACTON, MA 01720-3573

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22226
MA
1223G0001X
General Practice Dentistry
25779
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
9211482
MA
Enumeration date
06/30/2008
Last updated
07/07/2017
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