Provider Demographics
NPI:1003582883
Name:VIDYA KINI KUKKUNDUR, DDS PC
Entity Type:Organization
Organization Name:VIDYA KINI KUKKUNDUR, DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VIDYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KINI KUKKUNDUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:856-872-2622
Mailing Address - Street 1:2 PENDLETON CT
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8503
Mailing Address - Country:US
Mailing Address - Phone:609-903-0135
Mailing Address - Fax:
Practice Address - Street 1:525 ROUTE 73 S STE 105
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9643
Practice Address - Country:US
Practice Address - Phone:856-872-2622
Practice Address - Fax:856-596-1726
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIDYA KINI KUKKUNDUR, DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty