Individual
MRS. ANITHA REDDY DOMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BDS
Contact information
Practice address
260 JEFFERSON AVE SE STE 221, GRAND RAPIDS, MI 49503-4597
(616) 459-1267
(616) 459-0673
Mailing address
260 JEFFERSON AVE SE STE 221, GRAND RAPIDS, MI 49503-4597
(616) 459-1267
(616) 459-0673
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901019524
MI
Other
Enumeration date
08/15/2007
Last updated
05/06/2010
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