Provider Demographics
NPI:1346469699
Name:KAMDAR, KIRAN (BDS, MSD, PC)
Entity Type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:
Last Name:KAMDAR
Suffix:
Gender:F
Credentials:BDS, MSD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5460 LILBURN STONE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-2843
Mailing Address - Country:US
Mailing Address - Phone:770-923-2232
Mailing Address - Fax:770-923-2268
Practice Address - Street 1:5460 LILBURN STONE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-2843
Practice Address - Country:US
Practice Address - Phone:770-923-2232
Practice Address - Fax:770-923-2268
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA105971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00412079AMedicaid
GADN010597OtherGEORGIA LICENSE NUMBER
GA827601OtherUNITED CONCORDIA NUMBER
GABD1399206OtherDEA REGISTRATION NUMBER
GA00412079AMedicaid