Provider Demographics
NPI:1922403633
Name:PAIDIPATI, KAVITHA (DMD)
Entity type:Individual
Prefix:DR
First Name:KAVITHA
Middle Name:
Last Name:PAIDIPATI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 TRI PARK WAY
Mailing Address - Street 2:UNIT 2
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-6432
Mailing Address - Country:US
Mailing Address - Phone:573-529-3334
Mailing Address - Fax:
Practice Address - Street 1:3030 N BALLARD RD
Practice Address - Street 2:FORWARD DENTAL
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911
Practice Address - Country:US
Practice Address - Phone:920-954-8085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001012-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice