Individual
DR. KALYANI MADDALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2810 MORRIS AVE SUITE 202, UNION, NJ 07083
(908) 851-9292
(908) 851-9899
Mailing address
2810 MORRIS AVE SUITE 202, UNION, NJ 07083
(908) 851-9292
(908) 851-9899
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
22D102182400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0021555
—
NJ
01
—
538150
AETNA DMU
NJ
Enumeration date
02/12/2007
Last updated
01/25/2017
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