Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 29973 | TX |
Y | 1223P0221X | Pediatric Dentist | 29973 | TX |
NPI | 1053735993 |
---|---|
Provider Name | Priyanka Kainthla |
First Address | Dallas, TX 75243-4113 |
Second Address | Dallas, TX 75243-4113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2014 |
Last Update Date | 09/07/2016 |