Provider Demographics
NPI:1124380167
Name:MUKTAJEEVAN DENTAL ARTS, LLC
Entity Type:Organization
Organization Name:MUKTAJEEVAN DENTAL ARTS, LLC
Other - Org Name:EAST WINDSOR DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SNEHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-336-7735
Mailing Address - Street 1:104 HICKORY CORNER RD STE 202
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-2460
Mailing Address - Country:US
Mailing Address - Phone:609-336-7735
Mailing Address - Fax:
Practice Address - Street 1:104 HICKORY CORNER RD STE 202
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2460
Practice Address - Country:US
Practice Address - Phone:609-336-7735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02305200261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0207675Medicaid