Provider Demographics
NPI:1811228679
Name:KANNIKAL, JANICE (DMD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:KANNIKAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 CHAGALL CIR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-7526
Mailing Address - Country:US
Mailing Address - Phone:305-528-5884
Mailing Address - Fax:
Practice Address - Street 1:1401 FORUM WAY
Practice Address - Street 2:STE 800
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2325
Practice Address - Country:US
Practice Address - Phone:561-682-0999
Practice Address - Fax:561-683-0899
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN183271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice