Provider Demographics
NPI:1588895262
Name:VADDADI, SATYA VIJAY K (DDS)
Entity type:Individual
Prefix:MR
First Name:SATYA
Middle Name:VIJAY K
Last Name:VADDADI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:VIJAY
Other - Middle Name:KUMAR
Other - Last Name:VADDADISATYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1600 MACKENZIE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52411
Mailing Address - Country:US
Mailing Address - Phone:319-249-6970
Mailing Address - Fax:319-249-6970
Practice Address - Street 1:1000 42ND STEET SOUTHEAST RAPIDS DENTAL
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403
Practice Address - Country:US
Practice Address - Phone:319-249-6970
Practice Address - Fax:319-249-6970
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08675122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0004012Medicaid