Vijay Bhaskar Reddy Gaddam, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22226 Issued in MA

Practice address

1073 Riverdale St
West Springfield, MA 01089-4614

Phone

(413) 285-7114

Fax

(413) 285-7168

NPI assigned

Jun 30, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Smile Line PC

  • Dental Clinic/Center
  • West Springfield, MA
  • NPI 1457873895
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1499385600000",
    "number": "1821250820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 RAILROAD ST",
            "address_2": "2B",
            "city": "ACTON",
            "state": "MA",
            "postal_code": "017203573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1073 RIVERDALE ST",
            "city": "WEST SPRINGFIELD",
            "state": "MA",
            "postal_code": "010894614",
            "telephone_number": "413-285-7114",
            "fax_number": "413-285-7168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GADDAM",
        "first_name": "VIJAY BHASKAR",
        "middle_name": "REDDY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-30",
        "last_updated": "2017-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "25779",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "22226",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9211482",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole K Frank-Maslar, RDN, LDN
• Tracy Freeman, PT
• Morgan Froebel
• Amanda L Frye, BCBA
• Karl R Fuller, P.A.
• Olga Gaftanyuk, MD
• Carrie Ann Gagne
• Galaxy Healthcare Afc LLC
• Jordyn H Galgay
• Galileo Ventures LLC

• General Practice Dentistry in West Springfield, MA
• Providers in West Springfield, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.