Provider Demographics
NPI:1881865434
Name:KIRAN M. KAMDAR DBA NEIGHBORHOOD PEDIATRIC AND ADULT DENTISTRY
Entity Type:Organization
Organization Name:KIRAN M. KAMDAR DBA NEIGHBORHOOD PEDIATRIC AND ADULT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-923-2232
Mailing Address - Street 1:5460 LILBURN STONE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-2843
Mailing Address - Country:US
Mailing Address - Phone:770-923-2232
Mailing Address - Fax:770-923-2268
Practice Address - Street 1:5460 LILBURN STONE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-2843
Practice Address - Country:US
Practice Address - Phone:770-923-2232
Practice Address - Fax:770-923-2268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN105971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000412079AMedicaid