Provider Demographics
NPI:1992958219
Name:KUKLANI, RIYA MAHESH (BDS)
Entity type:Individual
Prefix:DR
First Name:RIYA
Middle Name:MAHESH
Last Name:KUKLANI
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:RAMCHANDANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-3449
Mailing Address - Fax:215-707-2781
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140
Practice Address - Country:US
Practice Address - Phone:215-707-3449
Practice Address - Fax:215-707-2781
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDRP 5481223P0106X
PADS0394141223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology