Provider Demographics
NPI:1730675349
Name:REDDY SABALAM, JYOTHSNA (DMD)
Entity type:Individual
Prefix:
First Name:JYOTHSNA
Middle Name:
Last Name:REDDY SABALAM
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 1:9121 OSTERVILLE DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-4329
Mailing Address - Country:US
Mailing Address - Phone:857-472-9026
Mailing Address - Fax:
Practice Address - Street 1:2416 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7773
Practice Address - Country:US
Practice Address - Phone:916-783-5241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1026931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice