Provider Demographics
NPI:1124582242
Name:DHINGRA, VARUN
Entity Type:Individual
Prefix:
First Name:VARUN
Middle Name:
Last Name:DHINGRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CENTRAL PARK APT 721
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-1188
Mailing Address - Country:US
Mailing Address - Phone:732-810-5487
Mailing Address - Fax:
Practice Address - Street 1:201 S EASTON RD
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-4428
Practice Address - Country:US
Practice Address - Phone:732-810-5487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30025634122300000X
MADN1858225122300000X
PADS042606122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1124582242Medicaid