Provider Demographics
NPI:1356469449
Name:VADIVEL, KUMAR T (DDS, FDS RCS, MS)
Entity Type:Individual
Prefix:DR
First Name:KUMAR
Middle Name:T
Last Name:VADIVEL
Suffix:
Gender:M
Credentials:DDS, FDS RCS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 WEST HEBRON PARKWAY STE 108
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010
Mailing Address - Country:US
Mailing Address - Phone:214-731-0123
Mailing Address - Fax:214-731-1122
Practice Address - Street 1:1500 WEST HEBRON PARKWAY STE 108
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010
Practice Address - Country:US
Practice Address - Phone:214-731-0123
Practice Address - Fax:214-731-1122
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212921223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX21292OtherTEXAS LICENSE NUMBER