Provider Demographics
NPI:1548044233
Name:REDDY, SAJAN ANISH (DMD)
Entity type:Individual
Prefix:DR
First Name:SAJAN
Middle Name:ANISH
Last Name:REDDY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17909 CACHET ISLE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2703
Mailing Address - Country:US
Mailing Address - Phone:813-325-0995
Mailing Address - Fax:
Practice Address - Street 1:17909 CACHET ISLE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2703
Practice Address - Country:US
Practice Address - Phone:813-325-0995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.10642122300000X
TN12348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist