Provider Demographics
NPI:1497783534
Name:MANDALAPU, BHRAMARESWARI (DDS)
Entity Type:Individual
Prefix:MRS
First Name:BHRAMARESWARI
Middle Name:
Last Name:MANDALAPU
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 1:1098 STELTON RD
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854
Mailing Address - Country:US
Mailing Address - Phone:732-748-2000
Mailing Address - Fax:866-822-8999
Practice Address - Street 1:636 EASTON AVE
Practice Address - Street 2:SUIT#A
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1975
Practice Address - Country:US
Practice Address - Phone:732-748-2000
Practice Address - Fax:732-377-3285
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022372001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0051241Medicaid