Provider Demographics
NPI:1215998315
Name:MUDULI, ANUP (DMD)
Entity type:Individual
Prefix:
First Name:ANUP
Middle Name:
Last Name:MUDULI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 RAMAPO VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-2524
Mailing Address - Country:US
Mailing Address - Phone:201-337-3797
Mailing Address - Fax:201-337-8845
Practice Address - Street 1:180 RAMAPO VALLEY RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-2524
Practice Address - Country:US
Practice Address - Phone:201-337-3797
Practice Address - Fax:201-337-8845
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1021606001223S0112X
NY0507191223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02680748Medicaid
NY02680748Medicaid