Provider Demographics
NPI:1770506909
Name:KAMODIA, SANJAY K (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:K
Last Name:KAMODIA
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:PO BOX 1273
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13851-1273
Mailing Address - Country:US
Mailing Address - Phone:607-770-7922
Mailing Address - Fax:
Practice Address - Street 1:3209 VESTAL PKWY E
Practice Address - Street 2:SUITE A
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2154
Practice Address - Country:US
Practice Address - Phone:607-770-7922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY42622-21223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice