Provider Demographics
NPI:1396128963
Name:ADVANI, MADHULIKA PRIYA (DMD)
Entity type:Individual
Prefix:DR
First Name:MADHULIKA
Middle Name:PRIYA
Last Name:ADVANI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 HUNTING RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903-3227
Mailing Address - Country:US
Mailing Address - Phone:203-322-0041
Mailing Address - Fax:
Practice Address - Street 1:118 SOUTH RIDGE ST
Practice Address - Street 2:SUITE 5
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573
Practice Address - Country:US
Practice Address - Phone:914-937-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042191122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist