Provider Demographics
NPI:1528706678
Name:PESARI, MEGHANA (DDS)
Entity type:Individual
Prefix:
First Name:MEGHANA
Middle Name:
Last Name:PESARI
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 1:5 BLACK GUM DR
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-1959
Mailing Address - Country:US
Mailing Address - Phone:732-425-3967
Mailing Address - Fax:
Practice Address - Street 1:960 SHOPPES BLVD # A1
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-2776
Practice Address - Country:US
Practice Address - Phone:732-258-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02969500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist