MEDICARE: DR. SANDHYA R KONDAPANENI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	22DI02313500	NJ

General Provider Information

NPI Number	:	1831316785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDHYA R KONDAPANENI

Provider Business Mailing Address
First Line	:	2502 JOHNSON CIR
Second Line	:
City	:	BRIDGEWATER
State	:	NJ
Zip	:	08807-5533
Country	:	US
Telephone Number	:	908-685-0910
Fax Number	:	609-695-2375

Provider Business Practice Location Address
First Line	:	2502 JOHNSON CIR
Second Line	:
City	:	BRIDGEWATER
State	:	NJ
Zip	:	08807-5533
Country	:	US
Telephone Number	:	908-685-0910
Fax Number	:	609-695-2375

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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