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General NPI Number Information
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NPI Number | 1336652239
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Entity Type | Individual
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Provider Name | JAGDESH DUDANI DMD, MS
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Gender | Male
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 630 S BREWSTER RD BLDG D
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City | VINELAND
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State | NJ
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Zip | 08361-7801
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Country | US
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Telephone | 609-805-6938
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Fax |
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Provider Business Mailing Address
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Address Line | 250 N COLUMBUS BLVD APT 611
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City | PHILADELPHIA
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State | PA
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Zip | 19106-1458
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Country | US
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Telephone | 310-717-2113
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 22DI02669500
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License Number State | NJ
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