Provider Demographics
NPI:1427439199
Name:MUKUNDA, HARSHITHA (DDS)
Entity type:Individual
Prefix:
First Name:HARSHITHA
Middle Name:
Last Name:MUKUNDA
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 1:931 FLETCHER AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-1293
Mailing Address - Country:US
Mailing Address - Phone:630-903-1100
Mailing Address - Fax:
Practice Address - Street 1:8060 N SHADELAND AVE STE B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2690
Practice Address - Country:US
Practice Address - Phone:317-288-5023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030340122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist