Provider Demographics
NPI:1215297288
Name:KUTHIALA, NEHA PAL (DDS)
Entity type:Individual
Prefix:DR
First Name:NEHA
Middle Name:PAL
Last Name:KUTHIALA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11949 SOUTHCREST LN
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-9132
Mailing Address - Country:US
Mailing Address - Phone:313-330-6160
Mailing Address - Fax:
Practice Address - Street 1:11949 SOUTHCREST LN
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-9132
Practice Address - Country:US
Practice Address - Phone:313-330-6160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI30613341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice