Provider Demographics
NPI:1720596778
Name:KANDYALA, REENA (DDS)
Entity Type:Individual
Prefix:DR
First Name:REENA
Middle Name:
Last Name:KANDYALA
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 1:11-4 ARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-3673
Mailing Address - Country:US
Mailing Address - Phone:832-841-5878
Mailing Address - Fax:
Practice Address - Street 1:1070 SAINT JAMES AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-1453
Practice Address - Country:US
Practice Address - Phone:413-278-6904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002034241223G0001X
CT126791223G0001X
MADN18592601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice