Healthcare Provider Details

I. General information

NPI: 1700569423
Provider Name (Legal Business Name): MINU DHUNGANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 08/09/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 N WESTERN AVE
MARION IN
46952-2505
US

IV. Provider business mailing address

14948 MIA DR
CARMEL IN
46033-8970
US

V. Phone/Fax

Practice location:
  • Phone: 317-249-0031
  • Fax:
Mailing address:
  • Phone: 317-249-0031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12014098A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: