Provider Demographics
NPI:1598491748
Name:KADAIKAL, BALRAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:BALRAM
Middle Name:
Last Name:KADAIKAL
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 1:1517 CHESAPEAKE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5086
Mailing Address - Country:US
Mailing Address - Phone:323-698-6161
Mailing Address - Fax:
Practice Address - Street 1:1437 S VALLEY MILLS DR, WACO, TX 76711
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711
Practice Address - Country:US
Practice Address - Phone:323-698-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX381131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice