KANDIMALLA DENTAL PLLC NPI 1558994392

NPI Information

  • NPI: 1558994392
  • Provider Name: KANDIMALLA DENTAL PLLC
  • Classification: Dentist - 1223G0001X
  • Specialization: General Practice
  • Entity Type: Organization
  • Doing Business As: INNOVA FAMILY DENTAL
  • Address: 772 S WEBER RD
    BOLINGBROOK, IL
    ZIP 60490
  • Phone: (630) 518-2272

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NPI Details

KANDIMALLA DENTAL PLLC is a general practice dentist in Bolingbrook, IL. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. KANDIMALLA DENTAL PLLC NPI is 1558994392. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Innova Family Dental.

The provider's business location address is:

772 S WEBER RD
BOLINGBROOK, IL
ZIP 60490-472
Phone: (630) 518-2272
Fax: (630) 243-4778

The provider's authorized official is Kalpana N Kandimalla .
The authorized official title is Owner Dentist and has the following contact phone number (630) 518-2272.

The enumeration date for this NPI number is 2/20/2020 and was last updated on 6/21/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1122300000XDentistNo
21223G0001XDentistGeneral PracticeYes

What is NPI?

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This page was last updated on: 3/30/2025

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