Provider Demographics
NPI:1013261080
Name:KANANI, KUNAL (DMD)
Entity Type:Individual
Prefix:
First Name:KUNAL
Middle Name:
Last Name:KANANI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 MAGNOLIA AVE
Mailing Address - Street 2:APT 416
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1845
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:122 AMITY RD
Practice Address - Street 2:DR. DENTAL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515
Practice Address - Country:US
Practice Address - Phone:203-389-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10874122300000X
CT0108741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist