Provider Demographics
NPI:1588979835
Name:MUCHINTAL, DIVYA R (DMD)
Entity type:Individual
Prefix:DR
First Name:DIVYA
Middle Name:R
Last Name:MUCHINTAL
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 1:1221 DENTON DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-3879
Mailing Address - Country:US
Mailing Address - Phone:732-428-5457
Mailing Address - Fax:
Practice Address - Street 1:1440 POTTSTOWN PIKE # 6
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-1271
Practice Address - Country:US
Practice Address - Phone:301-247-2701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0384691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice