Provider Demographics
NPI:1235316431
Name:SUKUMAR, PRADEEP (DMD)
Entity Type:Individual
Prefix:DR
First Name:PRADEEP
Middle Name:
Last Name:SUKUMAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RIVER CT
Mailing Address - Street 2:1112
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-2001
Mailing Address - Country:US
Mailing Address - Phone:201-725-7502
Mailing Address - Fax:
Practice Address - Street 1:1740 N OLDEN AVE
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-3110
Practice Address - Country:US
Practice Address - Phone:609-844-1222
Practice Address - Fax:609-844-1227
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023651001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice