Provider Demographics
NPI:1801306535
Name:KAA DENTAL LLC
Entity type:Organization
Organization Name:KAA DENTAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRAN
Authorized Official - Middle Name:VENKATA
Authorized Official - Last Name:NAYUDU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-288-9999
Mailing Address - Street 1:8100 RANDOLPH WAY APT 202
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4790
Mailing Address - Country:US
Mailing Address - Phone:443-902-1256
Mailing Address - Fax:
Practice Address - Street 1:10007 STEDWICK RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-3710
Practice Address - Country:US
Practice Address - Phone:240-288-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-08
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15464261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental