Provider Demographics
NPI:1457672966
Name:MOHAN, KATHIRAVAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHIRAVAN
Middle Name:
Last Name:MOHAN
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 1:250 SNAPDRAGON WAY
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-8215
Mailing Address - Country:US
Mailing Address - Phone:602-758-1319
Mailing Address - Fax:610-432-8150
Practice Address - Street 1:8555 INTERCHANGE RD
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-5611
Practice Address - Country:US
Practice Address - Phone:602-758-1319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038327122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist