Provider Demographics
NPI:1770841587
Name:KELLA, KAPIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAPIL
Middle Name:
Last Name:KELLA
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 1:5505 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1213
Mailing Address - Country:US
Mailing Address - Phone:737-273-7277
Mailing Address - Fax:773-639-1542
Practice Address - Street 1:5505 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1213
Practice Address - Country:US
Practice Address - Phone:773-273-7277
Practice Address - Fax:773-639-1542
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190292121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice