Provider Demographics
NPI:1194314864
Name:BLUSH DENTAL & ORTHODONTICS PC
Entity type:Organization
Organization Name:BLUSH DENTAL & ORTHODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:RASHMI
Authorized Official - Middle Name:
Authorized Official - Last Name:POREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-990-9030
Mailing Address - Street 1:216 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6601 S BRAESWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-3611
Practice Address - Country:US
Practice Address - Phone:832-930-7803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-15
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty