Provider Demographics
NPI:1477059145
Name:KONDUR, DILEEP R (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:DILEEP
Middle Name:R
Last Name:KONDUR
Suffix:
Gender:M
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 1:231 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2407
Mailing Address - Country:US
Mailing Address - Phone:706-863-4212
Mailing Address - Fax:
Practice Address - Street 1:231 DAVIS RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-2407
Practice Address - Country:US
Practice Address - Phone:706-863-4212
Practice Address - Fax:706-863-0087
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDRPM2050122300000X
GADN015814390200000X, 1223P0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program