Praveen Kumar Gonuguntla Kamma, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019032826 Issued in IL

Practice address

3650 W Stan Schlueter Loop Ste 160
Killeen, TX 76549-6814

Phone

(254) 699-6000

NPI assigned

Jul 23, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605571200000",
    "number": "1104479724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 WOLF RANCH PKWY APT 3213",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786287289",
            "telephone_number": "502-999-6322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 W STAN SCHLUETER LOOP STE 160",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765496814",
            "telephone_number": "254-699-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "802 N 9th St",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627026309",
            "country_code": "US",
            "telephone_number": "888-988-4066",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2608 State St",
            "address_purpose": "LOCATION",
            "city": "East Saint Louis",
            "state": "IL",
            "postal_code": "622052325",
            "country_code": "US",
            "telephone_number": "888-988-4066",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GONUGUNTLA KAMMA",
        "first_name": "PRAVEEN KUMAR",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-23",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "35519",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019032826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sydnee Golas
• Kristin Golden, SLP
• Janell Elain Goler
• Kendra Golphin
• Monica Ann Gomez
• Dawn Renee Gonzales, M.S.
• Katiria Marie Gonzalez Centeno
• Ezequiel Gonzalez Jr., DC
• Marissa Gonzalez
• Rebecca Gonzalez

• General Practice Dentistry in Killeen, TX
• Providers in Killeen, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.