# DR. KALYANI MADDALI

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1245372812
- **Gender:** F
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 22D102182400 | NJ | Yes |

## Other

- **Enumeration date:** 02/12/2007
- **Last updated:** 01/25/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0021555 | — | NJ |
| 01 | — | 538150 | AETNA DMU | NJ |