Provider Demographics
NPI:1851479273
Name:KALAKOTA, UMA REDDY (DMD)
Entity type:Individual
Prefix:DR
First Name:UMA
Middle Name:REDDY
Last Name:KALAKOTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 FOXWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-7187
Mailing Address - Country:US
Mailing Address - Phone:989-835-5727
Mailing Address - Fax:
Practice Address - Street 1:1411 CENTER AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6109
Practice Address - Country:US
Practice Address - Phone:989-892-7062
Practice Address - Fax:989-892-3561
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIUK0165641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4565520Medicaid