Provider Demographics
NPI:1386477206
Name:KANDOLA, JADE CAITILIN KAUR (DMD)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:CAITILIN KAUR
Last Name:KANDOLA
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 1:3440 E BASELINE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-7247
Mailing Address - Country:US
Mailing Address - Phone:480-926-2350
Mailing Address - Fax:
Practice Address - Street 1:3440 E BASELINE RD STE 106
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7247
Practice Address - Country:US
Practice Address - Phone:480-926-2350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0123031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice