Provider Demographics
NPI:1114099546
Name:LELE, KEDAR S (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEDAR
Middle Name:S
Last Name:LELE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3953 E PARADISE FALLS DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6688
Mailing Address - Country:US
Mailing Address - Phone:520-325-4746
Mailing Address - Fax:520-319-1031
Practice Address - Street 1:3953 E PARADISE FALLS DR
Practice Address - Street 2:SUITE 110
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6688
Practice Address - Country:US
Practice Address - Phone:520-325-4746
Practice Address - Fax:520-319-1031
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ67421223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ977473Medicaid