Provider Demographics
NPI:1902955693
Name:MUDGIL, VANITA AHUJA (DDS)
Entity Type:Individual
Prefix:DR
First Name:VANITA
Middle Name:AHUJA
Last Name:MUDGIL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 GRACE DR
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1221
Mailing Address - Country:US
Mailing Address - Phone:917-514-9539
Mailing Address - Fax:
Practice Address - Street 1:26 GRACE DR
Practice Address - Street 2:
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-1221
Practice Address - Country:US
Practice Address - Phone:917-514-9539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04946711223P0300X
NJ22DIO22058001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics