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General NPI Number Information
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NPI Number | 1720117849
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Entity Type | Organization
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Legal Business Name | DENTAL ILLUMINATIONS
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 660 PLAINSBORO ROAD PRINCETON MEADOWS SHOPPING CENTER
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City | PLAINSBORO
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State | NJ
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Zip | 08536
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Country | US
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Telephone | 609-275-9688
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Fax | 609-275-9673
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Provider Business Mailing Address
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Address Line | 660 PLAINSBORO ROAD PRINCETON MEADOWS SHOPPING CENTER
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City | PLAINSBORO
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State | NJ
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Zip | 08536
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Country | US
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Telephone | 609-275-9688
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Fax | 609-275-9673
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Authorized Official
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Title or Position | PRESIDENT AND OWNER DENTIST
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Name | DR. MADHAVI VENKATA KADIYALA
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Credential | DDS
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Telephone | 609-275-9688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DI20500
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License Number State | NJ
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