Healthcare Provider Details

I. General information

NPI: 1477059145
Provider Name (Legal Business Name): DILEEP R KONDUR DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 DAVIS RD
AUGUSTA GA
30907-2407
US

IV. Provider business mailing address

231 DAVIS RD
AUGUSTA GA
30907-2407
US

V. Phone/Fax

Practice location:
  • Phone: 706-863-4212
  • Fax: 706-863-0087
Mailing address:
  • Phone: 706-863-4212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDRPM2050
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDN015814
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN015814
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: