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Individual

DR. KAYATHRI PONNUSAMY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DMD

Contact information

Practice address
11137 W LINCOLN HWY, FRANKFORT, IL 60423-7428
(815) 277-2840
Mailing address
2389 RIVER HILLS LN, BOLINGBROOK, IL 60490-4938
(248) 704-5780

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.035105
IL

Other

Enumeration date
06/03/2024
Last updated
06/03/2024
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