Provider Demographics
NPI:1427102961
Name:BLOOM & REDDY DDS PC
Entity type:Organization
Organization Name:BLOOM & REDDY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAVITHA
Authorized Official - Middle Name:B
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:301-631-5860
Mailing Address - Street 1:130 THOMAS JOHNSON DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4582
Mailing Address - Country:US
Mailing Address - Phone:301-631-5860
Mailing Address - Fax:301-631-5861
Practice Address - Street 1:130 THOMAS JOHNSON DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4582
Practice Address - Country:US
Practice Address - Phone:301-631-5860
Practice Address - Fax:301-631-5861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD116281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty