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General NPI Number Information
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NPI Number | 1740482116
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Entity Type | Organization
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Legal Business Name | MRUDULA PINGILI DDS ,LLC
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 390 AMWELL RD SUITE 408 , BUILDING 4
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-1225
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Country | US
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Telephone | 908-874-5006
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Fax | 908-874-8272
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Provider Business Mailing Address
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Address Line | 390 AMWELL RD SUITE 408 , BUILDING 4
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-1225
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Country | US
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Telephone | 908-874-5006
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Fax | 908-874-8272
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Authorized Official
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Title or Position | OWNER
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Name | DR. MRUDULA PINGILI
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Credential | D.D.S
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Telephone | 908-874-5006
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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 | 22DI02220500
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License Number State | NJ
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