Provider Demographics
NPI:1376663252
Name:MULGUND, VANDANA D (DDS)
Entity Type:Individual
Prefix:DR
First Name:VANDANA
Middle Name:D
Last Name:MULGUND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14302 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2231
Mailing Address - Country:US
Mailing Address - Phone:718-539-5540
Mailing Address - Fax:718-539-1022
Practice Address - Street 1:14302 45TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2231
Practice Address - Country:US
Practice Address - Phone:718-539-5540
Practice Address - Fax:718-539-1022
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY356751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice