Provider Demographics
NPI:1437404407
Name:TAMMINIDI, KIRANKUMAR (DMD)
Entity Type:Individual
Prefix:
First Name:KIRANKUMAR
Middle Name:
Last Name:TAMMINIDI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 NORTHAMPTON ST APT 2608
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-4022
Mailing Address - Country:US
Mailing Address - Phone:617-784-4183
Mailing Address - Fax:
Practice Address - Street 1:4017 N PRINCE ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-9705
Practice Address - Country:US
Practice Address - Phone:575-762-2757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD37181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice