Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 019.033350 | IL |
N | 1223D0001X | Dental Public Health | 26156 | FL |
NPI | 1295308492 |
---|---|
Provider Name | Jessica Reddy |
First Address | Munster, IN 46321-5128 |
Second Address | Saint John, IN 46373-9400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2021 |
Last Update Date | 23/07/2021 |