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General NPI Number Information
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NPI Number | 1003582883
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Entity Type | Organization
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Legal Business Name | VIDYA KINI KUKKUNDUR, DDS PC
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Dates
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Enumeration Date | 08/20/2021
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Last Update Date | 08/20/2021
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Provider Practice Location Address
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Address Line | 525 ROUTE 73 S STE 105
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City | MARLTON
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State | NJ
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Zip | 08053-9643
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Country | US
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Telephone | 856-872-2622
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Fax | 856-596-1726
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Provider Business Mailing Address
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Address Line | 2 PENDLETON CT
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City | MEDFORD
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State | NJ
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Zip | 08055-8503
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Country | US
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Telephone | 609-903-0135
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. VIDYA KINI KUKKUNDUR
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Credential | DDS
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Telephone | 856-872-2622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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