Provider Demographics
NPI:1326326620
Name:THAMMINENI, KISHORE BABU (DDS)
Entity Type:Individual
Prefix:DR
First Name:KISHORE BABU
Middle Name:
Last Name:THAMMINENI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7360 GALLAGHER DR
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4531
Mailing Address - Country:US
Mailing Address - Phone:305-942-3458
Mailing Address - Fax:763-263-5822
Practice Address - Street 1:195 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55309-9572
Practice Address - Country:US
Practice Address - Phone:763-263-5822
Practice Address - Fax:763-263-5822
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13021122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist