Healthcare Provider Details

I. General information

NPI: 1114099546
Provider Name (Legal Business Name): KEDAR S. LELE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3953 E PARADISE FALLS DR SUITE 110
TUCSON AZ
85712-6688
US

IV. Provider business mailing address

3953 E PARADISE FALLS DR SUITE 110
TUCSON AZ
85712-6688
US

V. Phone/Fax

Practice location:
  • Phone: 520-325-4746
  • Fax: 520-319-1031
Mailing address:
  • Phone: 520-325-4746
  • Fax: 520-319-1031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6742
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: