Provider Demographics
NPI:1245480565
Name:PREETHY KUNTHARA DDS PC
Entity type:Organization
Organization Name:PREETHY KUNTHARA DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PREETHY
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:KUNTHARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-833-0880
Mailing Address - Street 1:1350 S LONGMORE
Mailing Address - Street 2:SUITE 13
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-9603
Mailing Address - Country:US
Mailing Address - Phone:480-833-0880
Mailing Address - Fax:480-833-0225
Practice Address - Street 1:1350 S LONGMORE
Practice Address - Street 2:SUITE 13
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-9603
Practice Address - Country:US
Practice Address - Phone:480-833-0880
Practice Address - Fax:480-833-0225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD56441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty