Provider Demographics
NPI:1467418269
Name:MENON, SUNITA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUNITA
Middle Name:
Last Name:MENON
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 1:13 SOMERDALE SQ
Mailing Address - Street 2:
Mailing Address - City:SOMERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08083-1345
Mailing Address - Country:US
Mailing Address - Phone:856-566-6969
Mailing Address - Fax:
Practice Address - Street 1:13 SOMERDALE SQ
Practice Address - Street 2:
Practice Address - City:SOMERDALE
Practice Address - State:NJ
Practice Address - Zip Code:08083-1345
Practice Address - Country:US
Practice Address - Phone:856-566-6969
Practice Address - Fax:856-566-6012
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022256001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice