Provider Demographics
NPI:1366690034
Name:KINI KUKKUNDUR, VIDYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIDYA
Middle Name:
Last Name:KINI KUKKUNDUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 ROUTE 73 S STE 105
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-9643
Mailing Address - Country:US
Mailing Address - Phone:856-872-2622
Mailing Address - Fax:856-596-1726
Practice Address - Street 1:525 ROUTE 73 S STE 105
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9643
Practice Address - Country:US
Practice Address - Phone:856-596-4333
Practice Address - Fax:856-596-1726
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023872001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty