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General NPI Number Information
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NPI Number | 1619155587
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Entity Type | Individual
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Provider Name | MADHAV MUKUNDAN D.D.S
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Gender | Male
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Dates
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Enumeration Date | 02/03/2008
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 1053 S GREEN VALLEY RD
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City | WATSONVILLE
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State | CA
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Zip | 95076-4164
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Country | US
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Telephone | 831-515-3006
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Fax |
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Provider Business Mailing Address
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Address Line | 300 GLENWOOD CIR APT 214
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City | MONTEREY
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State | CA
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Zip | 93940-4710
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Country | US
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Telephone | 917-385-0549
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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 | 59239
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License Number State | CA
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