Provider Demographics
NPI:1548464860
Name:MUTHUKUMARAN, MOHANA (DMD)
Entity type:Individual
Prefix:DR
First Name:MOHANA
Middle Name:
Last Name:MUTHUKUMARAN
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:#1616 BRUNSWICK AVE.
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648
Mailing Address - Country:US
Mailing Address - Phone:609-392-5515
Mailing Address - Fax:609-392-5464
Practice Address - Street 1:1616 BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4630
Practice Address - Country:US
Practice Address - Phone:609-392-5515
Practice Address - Fax:609-392-5464
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI019518001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice