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General NPI Number Information
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NPI Number | 1437519063
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Entity Type | Individual
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Provider Name | MAWNA DHAMOTHARAN KUMAR DMD
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Gender | Female
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Dates
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Enumeration Date | 02/24/2016
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 12111 ALCOSTA BLVD
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City | SAN RAMON
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State | CA
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Zip | 94583-2637
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Country | US
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Telephone | 925-216-2544
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Fax |
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Provider Business Mailing Address
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Address Line | 4129 HEALDSBURG WAY
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City | DUBLIN
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State | CA
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Zip | 94568-4671
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Country | US
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Telephone | 925-216-2544
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI02630400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DDS103379
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License Number State | CA
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