Provider Demographics
NPI:1346804994
Name:YADAV, MUDIT KRISHNA
Entity type:Individual
Prefix:DR
First Name:MUDIT
Middle Name:KRISHNA
Last Name:YADAV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 E ARROW HWY STE B
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3347
Mailing Address - Country:US
Mailing Address - Phone:909-927-8880
Mailing Address - Fax:
Practice Address - Street 1:570 E ARROW HWY STE B
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3347
Practice Address - Country:US
Practice Address - Phone:424-571-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE609362811223G0001X
CA103833122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice