Provider Demographics
NPI:1720117849
Name:DENTAL ILLUMINATIONS
Entity Type:Organization
Organization Name:DENTAL ILLUMINATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MADHAVI
Authorized Official - Middle Name:VENKATA
Authorized Official - Last Name:KADIYALA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-275-9688
Mailing Address - Street 1:660 PLAINSBORO ROAD
Mailing Address - Street 2:PRINCETON MEADOWS SHOPPING CENTER
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536
Mailing Address - Country:US
Mailing Address - Phone:609-275-9688
Mailing Address - Fax:609-275-9673
Practice Address - Street 1:660 PLAINSBORO ROAD
Practice Address - Street 2:PRINCETON MEADOWS SHOPPING CENTER
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536
Practice Address - Country:US
Practice Address - Phone:609-275-9688
Practice Address - Fax:609-275-9673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI205001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty