Provider Demographics
NPI:1396355020
Name:REDDY, SIDHARTH POOLAPALLI (DDS)
Entity type:Individual
Prefix:DR
First Name:SIDHARTH
Middle Name:POOLAPALLI
Last Name:REDDY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7614 GRANITE DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2184
Mailing Address - Country:US
Mailing Address - Phone:281-636-0743
Mailing Address - Fax:
Practice Address - Street 1:525 DODDRIDGE ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2371
Practice Address - Country:US
Practice Address - Phone:361-854-7999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX364971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice