Provider Demographics
NPI:1114163227
Name:D KUNDRA DDS INC.
Entity Type:Organization
Organization Name:D KUNDRA DDS INC.
Other - Org Name:PETALUMA DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARPAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNDRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-778-9000
Mailing Address - Street 1:1580 E WASHINGTON ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-3679
Mailing Address - Country:US
Mailing Address - Phone:707-778-9000
Mailing Address - Fax:707-778-2050
Practice Address - Street 1:1580 E WASHINGTON ST
Practice Address - Street 2:SUITE 107
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-3679
Practice Address - Country:US
Practice Address - Phone:707-778-9000
Practice Address - Fax:707-778-2050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA558711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty