Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 11676 | MA |
NPI | 1356477301 |
---|---|
Provider Name | Dr. Raghuram Reddy |
First Address | Sharon, MA 02067-1270 |
Second Address | Westborough, MA 01581-3988 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 08/07/2007 |