Provider Demographics
NPI:1952010597
Name:KANYAL, KALPANA (DMD)
Entity Type:Individual
Prefix:DR
First Name:KALPANA
Middle Name:
Last Name:KANYAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 MODAFF RD UNIT A2
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-6166
Mailing Address - Country:US
Mailing Address - Phone:650-703-2064
Mailing Address - Fax:
Practice Address - Street 1:10 S LARKIN AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60436-1243
Practice Address - Country:US
Practice Address - Phone:815-773-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190344661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty