Provider Demographics
NPI:1538227129
Name:REDDY, KOUSALYA R (DDS)
Entity type:Individual
Prefix:DR
First Name:KOUSALYA
Middle Name:R
Last Name:REDDY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:K.R
Other - Middle Name:R
Other - Last Name:REDDY
Other - Suffix:IV
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3166 N LINCOLN AVE
Mailing Address - Street 2:SUITE NO 317
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3133
Mailing Address - Country:US
Mailing Address - Phone:773-281-8933
Mailing Address - Fax:773-281-8933
Practice Address - Street 1:3166 N LINCOLN AVE
Practice Address - Street 2:SUITE NO 317
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3133
Practice Address - Country:US
Practice Address - Phone:773-281-8933
Practice Address - Fax:773-281-8933
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist