Healthcare Provider Details

I. General information

NPI: 1215998315
Provider Name (Legal Business Name): ANUP MUDULI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 RAMAPO VALLEY RD
OAKLAND NJ
07436-2524
US

IV. Provider business mailing address

180 RAMAPO VALLEY RD
OAKLAND NJ
07436-2524
US

V. Phone/Fax

Practice location:
  • Phone: 201-337-3797
  • Fax: 201-337-8845
Mailing address:
  • Phone: 201-337-3797
  • Fax: 201-337-8845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22D102160600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number050719
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: