Provider Demographics
NPI:1295496420
Name:MADDALI & ASSOCIATES PC
Entity type:Organization
Organization Name:MADDALI & ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDEN
Authorized Official - Prefix:DR
Authorized Official - First Name:KALYANI
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDALI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-232-9468
Mailing Address - Street 1:2810 MORRIS AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4841
Mailing Address - Country:US
Mailing Address - Phone:908-851-9292
Mailing Address - Fax:
Practice Address - Street 1:2810 MORRIS AVE STE 202
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-4841
Practice Address - Country:US
Practice Address - Phone:908-851-9292
Practice Address - Fax:908-851-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty