Kalyan Chakravarthy Kondreddi, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D14496 Issued in MN

Practice address

30 Main St
Medford, MA 02155-7102

Phone

(781) 391-2440

NPI assigned

Oct 20, 2020

Last updated

Oct 28, 2022By the provider in NPPES

Sex

Male

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Medford Square Dentistry and Implants LLC

  • Dental Clinic/Center
  • Medford, MA
  • NPI 1295400588
  NPD
• Nanette Demonteverde, DMD, PC

  • General Practice Dentistry
  • Medford, MA
  • NPI 1346463973
  NPD (past)

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

{
    "created_epoch": "1603152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666915200000",
    "number": "1962001149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 MAIN ST",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021557102",
            "telephone_number": "781-391-2440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 MAIN ST",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021557102",
            "telephone_number": "781-391-2440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONDREDDI",
        "first_name": "KALYAN",
        "middle_name": "CHAKRAVARTHY",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-20",
        "last_updated": "2022-10-28",
        "certification_date": "2022-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D14496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlin Klockner, NP
• Zoe Elizabeth Knijn
• Bing Ko, M.D., SC.D.
• Steffi Koerner
• Zara Konarski, PMHCNS
• Emily Catherine Konstan
• Hope Koram, LMHC
• Jillian Lee Korb, CCC-SLP
• Abigail Kowalski
• Steffanie Kraucunas, RN

• General Practice Dentistry in Medford, MA
• Providers in Medford, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 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.