Organization
KANDIMALLA DENTAL PLLC
Active
Other names
Innova Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KALPANA N KANDIMALLA DDS (OWNER DENTIST)
(630) 518-2272
Entity
Organization
Contact information
Practice address
772 S WEBER RD, BOLINGBROOK, IL 60490-5472
(630) 518-2272
(630) 243-4778
Mailing address
772 S WEBER RD, BOLINGBROOK, IL 60490-5472
(630) 518-2272
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
02/20/2020
Last updated
06/21/2022
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