Provider Demographics
NPI:1558162289
Name:KANDI DENTAL PC
Entity type:Organization
Organization Name:KANDI DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KAVEH
Authorized Official - Middle Name:
Authorized Official - Last Name:KANDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:224-217-5400
Mailing Address - Street 1:2604 DEMPSTER ST STE 502
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-8429
Mailing Address - Country:US
Mailing Address - Phone:224-217-5400
Mailing Address - Fax:224-217-5405
Practice Address - Street 1:2604 DEMPSTER ST STE 502
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-8429
Practice Address - Country:US
Practice Address - Phone:224-217-5400
Practice Address - Fax:224-217-5405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty