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General NPI Number Information
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NPI Number | 1801306535
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Entity Type | Organization
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Legal Business Name | KAA DENTAL LLC
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Dates
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Enumeration Date | 10/08/2017
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Last Update Date | 12/21/2018
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Provider Practice Location Address
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Address Line | 10007 STEDWICK RD
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City | MONTGOMERY VILLAGE
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State | MD
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Zip | 20886-3710
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Country | US
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Telephone | 240-288-9999
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Fax |
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Provider Business Mailing Address
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Address Line | 8100 RANDOLPH WAY APT 202
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City | ELLICOTT CITY
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State | MD
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Zip | 21043-4790
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Country | US
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Telephone | 443-902-1256
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. KIRAN VENKATA NAYUDU
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Credential | DDS
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Telephone | 240-288-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 15464
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License Number State | MD
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