| Divya Peddireddy Dental Corporation | |
|
3070 Bristol St Ste 180 Costa Mesa CA 92626-3072 | |
| (714) 924-4824 | |
| Not Available |
| Full Name | Divya Peddireddy Dental Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 3070 Bristol St Ste 180, Costa Mesa, California |
| Authorized Official Name and Position | Divya Peddireddy (SOLE OWNER) |
| Authorized Official Contact | 5626508076 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Divya Peddireddy Dental Corporation 3070 Bristol St Ste 180 Costa Mesa CA 92626-3072 Ph: () - | Divya Peddireddy Dental Corporation 3070 Bristol St Ste 180 Costa Mesa CA 92626-3072 Ph: (714) 924-4824 |
| NPI Number | 1164287710 |
|---|---|
| Provider Enumeration Date | 02/13/2024 |
| Last Update Date | 02/13/2024 |
| Medicare PECOS PAC ID | 7012352719 |
|---|---|
| Medicare Enrollment ID | O20240305000297 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164287710 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Divya Reddy Peddireddy |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1356782080 PECOS PAC ID: 8123337649 Enrollment ID: I20240305000336 |
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