Provider Demographics
NPI:1831316785
Name:KONDAPANENI, SANDHYA R
Entity Type:Individual
Prefix:DR
First Name:SANDHYA
Middle Name:R
Last Name:KONDAPANENI
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SANDHYA
Other - Middle Name:R
Other - Last Name:GANGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2502 JOHNSON CIR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-5533
Mailing Address - Country:US
Mailing Address - Phone:908-685-0910
Mailing Address - Fax:609-695-2375
Practice Address - Street 1:2502 JOHNSON CIR
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-5533
Practice Address - Country:US
Practice Address - Phone:908-685-0910
Practice Address - Fax:609-695-2375
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023135001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice