Provider Demographics
NPI:1992917496
Name:GIULIANELLI, KADAM DESAI (DMD)
Entity type:Individual
Prefix:DR
First Name:KADAM
Middle Name:DESAI
Last Name:GIULIANELLI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KADAM
Other - Middle Name:DESAI
Other - Last Name:GIULIANELLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:110 KIMBALL AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6833
Mailing Address - Country:US
Mailing Address - Phone:802-864-6264
Mailing Address - Fax:802-864-6402
Practice Address - Street 1:110 KIMBALL AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6833
Practice Address - Country:US
Practice Address - Phone:802-864-6264
Practice Address - Fax:802-864-6402
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0539401223G0001X
VT016.0002257122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice