Kandimalla Dental PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

KANDIMALLA DENTAL PLLC

Doing business as

Innova Family Dental

Practice address

772 S Weber Rd
Bolingbrook, IL 60490-5472

Phone

(630) 518-2272

Fax

(630) 243-4778

NPI assigned

Feb 20, 2020

Last updated

Jun 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kalpana N Kandimalla, DDSNPI 1477743524

Title

Owner Dentist

Phone

(630) 518-2272

Specialties & licenses 2

Addresses

Other names 1

• Innova Family Dental Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kalpana Nagadeepthi Kandimalla, DDS

  • Dentist
  • Bolingbrook, IL
  • NPI 1477743524
  NPD Authorized official

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

{
    "created_epoch": "1582156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655769600000",
    "number": "1558994392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "772 S WEBER RD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604905472",
            "telephone_number": "630-518-2272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "772 S WEBER RD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604905472",
            "telephone_number": "630-518-2272",
            "fax_number": "630-243-4778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KANDIMALLA DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-20",
        "last_updated": "2022-06-21",
        "certification_date": "2022-06-21",
        "status": "A",
        "authorized_official_last_name": "KANDIMALLA",
        "authorized_official_first_name": "KALPANA",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "630-518-2272",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innova Family Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Innova Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary Ann Kalmanek, D.D.S.
• Stephen Kalmar, M.D.
• Natalie Joann Kalvoda, FNP
• Mattie M Kaminskas, ATC
• Lori Lynn Kampschoer, DENTAL HYGIENIST
• Kalpana Nagadeepthi Kandimalla, DDS
• Andiopi Kapidis, DT
• Jennifer M Kaput
• Kathleen Michele Kasmer, O.D.
• Todd John Kastler, CLMT

• General Practice Dentistry in Bolingbrook, IL
• Providers in Bolingbrook, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2022; 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.