Provider Demographics
NPI:1366964884
Name:MUDALIAR, AAKASH CHAMU (BDS, MHA, DMD, FICOI)
Entity type:Individual
Prefix:
First Name:AAKASH
Middle Name:CHAMU
Last Name:MUDALIAR
Suffix:
Gender:M
Credentials:BDS, MHA, DMD, FICOI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 POST OFFICE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-1913
Mailing Address - Country:US
Mailing Address - Phone:301-843-3444
Mailing Address - Fax:
Practice Address - Street 1:605 POST OFFICE RD STE 203
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-1913
Practice Address - Country:US
Practice Address - Phone:301-843-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0414611223G0001X
DCDEN20001401223G0001X
MD169001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD16900OtherMARYLAND DEPARTMENT OF HEALTH
DCDEN2000140OtherTHE DISTRICT OF COLUMBIA BOARD OF DENTISTRY
PADS041461OtherDENTAL LICENSE