Healthcare Provider Details

I. General information

NPI: 1811228679
Provider Name (Legal Business Name): JANICE KANNIKAL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 FORUM WAY STE 800
WEST PALM BEACH FL
33401-2325
US

IV. Provider business mailing address

2124 CHAGALL CIR
WEST PALM BEACH FL
33409-7526
US

V. Phone/Fax

Practice location:
  • Phone: 561-682-0999
  • Fax: 561-683-0899
Mailing address:
  • Phone: 305-528-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN18327
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: