Provider Demographics
NPI:1154871325
Name:KADAGAD, POORNIMA (DMD)
Entity type:Individual
Prefix:DR
First Name:POORNIMA
Middle Name:
Last Name:KADAGAD
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 1:723 FOXON RD
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-1873
Mailing Address - Country:US
Mailing Address - Phone:203-466-7400
Mailing Address - Fax:203-466-7401
Practice Address - Street 1:723 FOXON RD
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-1873
Practice Address - Country:US
Practice Address - Phone:203-466-7400
Practice Address - Fax:203-466-7401
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11732122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist