Provider Demographics
NPI:1245754415
Name:MUDAN, DAVINDER (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVINDER
Middle Name:
Last Name:MUDAN
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 1:49362 SANDRA DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3534
Mailing Address - Country:US
Mailing Address - Phone:616-886-3191
Mailing Address - Fax:
Practice Address - Street 1:33080 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-1867
Practice Address - Country:US
Practice Address - Phone:586-293-8750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53150874421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice