Healthcare Provider Details

I. General information

NPI: 1346761640
Provider Name (Legal Business Name): RAHUL KALLIANPUR D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MCCLELLAN ST
SCHENECTADY NY
12304-1009
US

IV. Provider business mailing address

600 MCCLELLAN ST
SCHENECTADY NY
12304-1009
US

V. Phone/Fax

Practice location:
  • Phone: 518-347-5293
  • Fax: 518-347-5196
Mailing address:
  • Phone: 518-347-5293
  • Fax: 518-347-5196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: