Leela Buddaraju

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

100274915 Issued in WI

Practice address

6430 Green Bay Rd Ste 112
Kenosha, WI 53142-2948

Phone

(262) 653-3980

NPI assigned

Feb 4, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Familia Dental Kenosha LLC

  • Dental Clinic/Center
  • Kenosha, WI
  • NPI 1154782209

  General Practice

  NPD

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

{
    "created_epoch": "1643932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643932800000",
    "number": "1801540281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2494 WATERBURY LN",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600896890",
            "telephone_number": "224-334-9307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6430 GREEN BAY RD STE 112",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422948",
            "telephone_number": "262-653-3980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUDDARAJU",
        "first_name": "LEELA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-04",
        "last_updated": "2022-02-04",
        "certification_date": "2022-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "100274915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theresa A. Bruner-Leydens, LPC
• Ottie Bruno, PT
• Mitchell Lee Buban
• Coral Tanzey Buchaklian, PHARMD
• Jocelyn Marie Buchholtz
• Ernesto Erfe Buencamino, MD
• Christine Ann Buffone, M.P.T.
• Kendall Alexis Bunnell
• Mark J. Buratti, D.D.S.
• Rebecca J Burchi

• General Practice Dentistry in Kenosha, WI
• Providers in Kenosha, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 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.