Provider Demographics
NPI:1396954251
Name:DODDAMANE, KAVITA (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:KAVITA
Middle Name:
Last Name:DODDAMANE
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SUNCREEK DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-2833
Mailing Address - Country:US
Mailing Address - Phone:214-547-9111
Mailing Address - Fax:214-547-9113
Practice Address - Street 1:107 SUNCREEK DR
Practice Address - Street 2:SUITE 120
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-2833
Practice Address - Country:US
Practice Address - Phone:214-547-9111
Practice Address - Fax:214-547-9113
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205491223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics