Provider Demographics
NPI:1871173278
Name:KELLA DDS CORP
Entity type:Organization
Organization Name:KELLA DDS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUNJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-355-1359
Mailing Address - Street 1:10811 WASHINGTON BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3660
Mailing Address - Country:US
Mailing Address - Phone:310-839-8033
Mailing Address - Fax:
Practice Address - Street 1:10811 WASHINGTON BLVD STE 302
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3660
Practice Address - Country:US
Practice Address - Phone:310-839-8033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental