Provider Demographics
NPI:1902314438
Name:KALLAM PLLC
Entity Type:Organization
Organization Name:KALLAM PLLC
Other - Org Name:V SMILE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIPPIREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-766-7050
Mailing Address - Street 1:12388 FM 423 STE 100
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-4961
Mailing Address - Country:US
Mailing Address - Phone:469-766-7050
Mailing Address - Fax:214-872-2701
Practice Address - Street 1:12388 FM 423 STE 100
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4961
Practice Address - Country:US
Practice Address - Phone:469-766-7050
Practice Address - Fax:214-872-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24264122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty