Provider Demographics
NPI:1548326804
Name:MOHAN, MADHU (DMD)
Entity type:Individual
Prefix:DR
First Name:MADHU
Middle Name:
Last Name:MOHAN
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 1:14 NEW CASTLE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07727-4005
Mailing Address - Country:US
Mailing Address - Phone:732-231-6688
Mailing Address - Fax:
Practice Address - Street 1:55 MOUNTAIN BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-2615
Practice Address - Country:US
Practice Address - Phone:908-791-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022573001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry