Provider Demographics
NPI:1447981287
Name:MALIREDDY, PRATYUSHA (DDS)
Entity type:Individual
Prefix:DR
First Name:PRATYUSHA
Middle Name:
Last Name:MALIREDDY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9208 LIMONCILLO DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-3450
Mailing Address - Country:US
Mailing Address - Phone:512-994-6200
Mailing Address - Fax:
Practice Address - Street 1:5820 WALZEM RD
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78218-2256
Practice Address - Country:US
Practice Address - Phone:210-375-3395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38593122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX38593OtherDENTAL LICENSE