Provider Demographics
NPI:1073098158
Name:KANTHI J APPANNAGARI PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:KANTHI J APPANNAGARI PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KANTHI
Authorized Official - Middle Name:J
Authorized Official - Last Name:APPANNAGARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-371-0776
Mailing Address - Street 1:17400 IRVINE BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3030
Mailing Address - Country:US
Mailing Address - Phone:714-371-0776
Mailing Address - Fax:714-371-0179
Practice Address - Street 1:17400 IRVINE BLVD STE E
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3030
Practice Address - Country:US
Practice Address - Phone:714-371-0776
Practice Address - Fax:714-371-0179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-25
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty