Provider Demographics
NPI:1750577169
Name:KUMAR, KAUSALYA (DDS)
Entity type:Individual
Prefix:DR
First Name:KAUSALYA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KAUSALYA
Other - Middle Name:
Other - Last Name:DHANDAPANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:742 HERITAGE PL
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6242
Mailing Address - Country:US
Mailing Address - Phone:916-934-3194
Mailing Address - Fax:
Practice Address - Street 1:742 HERITAGE PL
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6242
Practice Address - Country:US
Practice Address - Phone:916-934-3194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56207122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist