Healthcare Provider Details

I. General information

NPI: 1982718136
Provider Name (Legal Business Name): KANNAN KOMANDUR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N CLEVELAND MASSILLON RD STE 106
AKRON OH
44333-3332
US

IV. Provider business mailing address

525 N CLEVELAND MASSILLON RD STE 106
AKRON OH
44333-3332
US

V. Phone/Fax

Practice location:
  • Phone: 330-666-1855
  • Fax: 330-666-1990
Mailing address:
  • Phone: 330-666-1855
  • Fax: 330-666-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number50627
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.027406
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: