Provider Demographics
NPI:1437519063
Name:DHAMOTHARAN KUMAR, MAWNA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAWNA
Middle Name:
Last Name:DHAMOTHARAN KUMAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4129 HEALDSBURG WAY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-4671
Mailing Address - Country:US
Mailing Address - Phone:925-216-2544
Mailing Address - Fax:
Practice Address - Street 1:12111 ALCOSTA BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-2637
Practice Address - Country:US
Practice Address - Phone:925-216-2544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026304001223G0001X
CADDS103379122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice