Healthcare Provider Details

I. General information

NPI: 1962070409
Provider Name (Legal Business Name): PUJA KEDIA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25102 BROOKPARK RD
NORTH OLMSTED OH
44070-6414
US

IV. Provider business mailing address

5480 JACQUELINE LN
NORTH OLMSTED OH
44070-3888
US

V. Phone/Fax

Practice location:
  • Phone: 440-471-6133
  • Fax:
Mailing address:
  • Phone: 440-590-2179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.026616
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: