Provider Demographics
NPI:1124358999
Name:ENJATI, MOHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOHAN
Middle Name:
Last Name:ENJATI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 HOOPER AVE
Mailing Address - Street 2:SUITE 201 B
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-8361
Mailing Address - Country:US
Mailing Address - Phone:732-914-1039
Mailing Address - Fax:732-914-8472
Practice Address - Street 1:1540 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-1852
Practice Address - Country:US
Practice Address - Phone:732-914-1039
Practice Address - Fax:732-914-8472
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI0242741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice