Peterson & Reddy, D.D.S., P.A.
Dentist, General Practice in Waldorf, MD. Organization (NPI-2).
NPI number1649489352
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1649489352
- Entity type
- Organization (NPI-2)
- Legal business name
- Peterson & Reddy, D.D.S., P.A.
- Organization subpart
- No
- Enumeration date
- May 21, 2007
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 12834 | MD | Yes |
Practice location
11855 Holly LnSuite 103
Waldorf, MD 20601-3114
Phone 301-843-3367
Mailing address
11855 Holly LnSuite 103
Waldorf, MD 20601-3114
Authorized official
Ajay Reddy
Vice-President
3018433367
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