Provider Demographics
NPI:1336652239
Name:DUDANI, JAGDESH (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JAGDESH
Middle Name:
Last Name:DUDANI
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N COLUMBUS BLVD APT 611
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-1458
Mailing Address - Country:US
Mailing Address - Phone:310-717-2113
Mailing Address - Fax:
Practice Address - Street 1:630 S BREWSTER RD BLDG D
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-7801
Practice Address - Country:US
Practice Address - Phone:609-805-6938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026695001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics