Provider Demographics
NPI:1891000402
Name:KAKADE, TEJAL ASHOK (DMD)
Entity Type:Individual
Prefix:
First Name:TEJAL
Middle Name:ASHOK
Last Name:KAKADE
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 1:115 W LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-8231
Mailing Address - Country:US
Mailing Address - Phone:678-234-9466
Mailing Address - Fax:
Practice Address - Street 1:406 DIXIE ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3922
Practice Address - Country:US
Practice Address - Phone:678-234-9466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0141471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice