KUNDURU DENTAL PLLC (NPI# 1629598586) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629598586 |
| Entity Type | Organization |
| Organization Name | KUNDURU DENTAL PLLC |
| Practice Address |
4164 S Broadway Ave Tyler TX 75701-8719 |
| Mailing Address |
Po Box 3189 Syracuse NY 13220-3189 |
| Practice Telephone | 9039390703 |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2017-06-22 |
| Authorized Official Name | HEMANTH KUNDURU (OWNER) |
| Authorized Official Telephone | 3154546000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Street Address |
4164 S BROADWAY AVE |
| City | TYLER |
| State | TX |
| Zip Code | 75701-8719 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821616186 | Honglam Thi Vo | Dentist | 4164 S Broadway Ave, Tyler, TX 75701-8719 | 2020-07-13 |
| 1952959322 | Justin M Stephens | Dentist | 4164 S Broadway Ave, Tyler, TX 75701-8719 | 2019-08-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962057059 | Gonzalo Fernandez | Physical Therapy Assistant | 753 S Beckham Ave, Tyler, TX 75701 | 2019-08-06 |
| 1215422654 | Adrianna Bussell | Nurse Practitioner | 1000 South Beckham, Tyler, TX 75701 | 2018-06-28 |
| 1285128017 | Idowu Akintokunbo Akinyele | Dentist | Aspen Dental, 4164 S Broadway Ave, Tyler, TX 75701 | 2018-06-15 |
| 1992208912 | Heather Renee Vancleave | Occupational Therapy Assistant | 1228 Louann Lane, Tyler, TX 75701 | 2018-03-15 |
| 1497260533 | Smile Workshop Mckinney, Pllc | Dentist | 301 N. Custer Rd, Mckinney, TX 75701 | 2017-12-12 |
| 1396266441 | Eye Surgery Center of East Texas, Pllc | Clinic/Center | 2448 E 5th St, Tyler, TX 75701 | 2017-06-29 |
| 1962936369 | Collins Complete Family Care | Nurse Practitioner | 1910 E Se Loop 323 # 176, Tyler, TX 75701 | 2017-04-12 |
| 1386187052 | Fellowship Health Team LLC | Home Health | 1124 S Fleishel Ave, Tyler, TX 75701 | 2016-11-29 |
| 1205382454 | Brenton Robinson | Nurse Practitioner | 1100 East Lake St, 160, Tyler, TX 75701 | 2016-08-28 |
| 1851846208 | Care First Pharmacy, LLC | Pharmacy | 1910 Roseland Blvd A, Tyler, TX 75701 | 2016-08-15 |
| Find all providers in zip 75701 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093329534 | Professional Dental Alliance of Tx 43004 Pllc | Dentist | 212 Old Grande Blvd Ste B224, Tyler, TX 75703-4277 | 2020-09-02 |
| 1679183446 | Valerie Marie Cano | Dentist | 7223 Crosswater, Tyler, TX 75703-0719 | 2020-08-05 |
| 1033770227 | Rajamanoj Kondaveeti | Dentist | 3873 Tx-64, Tyler, TX 75704 | 2019-06-27 |
| 1538720016 | Trevor Justin Wortley | Dentist | 8942 S Broadway Ave Ste 128, Tyler, TX 75703-5443 | 2019-06-25 |
| 1710473681 | Justin Taylor Ross | Dentist | 8938 S Broadway Ave Ste 380, Tyler, TX 75703 | 2018-07-03 |
| 1285128017 | Idowu Akintokunbo Akinyele | Dentist | Aspen Dental, 4164 S Broadway Ave, Tyler, TX 75701 | 2018-06-15 |
| 1457843450 | Adam Tyler Barnes, Dds of Texas II, Pllc | Dentist | 8938 South Broadway, Ste 480, Tyler, TX 75703 | 2018-06-05 |
| 1992217947 | Charles Cox IIi | Dentist | 1327 S Baxter Ave, Tyler, TX 75701-3404 | 2017-10-31 |
| 1326559022 | Blu Dental Group PC | Dentist | 3975 Old Jacksonville Rd, Tyler, TX 75701-8519 | 2017-10-20 |
| 1639549454 | Pine Creek Dental, Pllc | Dentist | 7925 S Broadway Ave Ste 300, Tyler, TX 75703-5227 | 2015-10-06 |
| Find all providers in TYLER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.