Provider Demographics
NPI:1467996199
Name:IRONDI, KAMDI AHUAMANTA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAMDI
Middle Name:AHUAMANTA
Last Name:IRONDI
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 1:130 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2918
Mailing Address - Country:US
Mailing Address - Phone:802-447-7682
Mailing Address - Fax:
Practice Address - Street 1:130 UNION ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2918
Practice Address - Country:US
Practice Address - Phone:802-447-7682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.0124902122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist