Provider Demographics
NPI:1518258243
Name:MARU, AVNI (DMD)
Entity Type:Individual
Prefix:
First Name:AVNI
Middle Name:
Last Name:MARU
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 1:100 CHRISTOPHER COLUMBUS DR
Mailing Address - Street 2:APT 2511
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-5546
Mailing Address - Country:US
Mailing Address - Phone:270-302-6692
Mailing Address - Fax:
Practice Address - Street 1:1130 MAXWELL LN
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6872
Practice Address - Country:US
Practice Address - Phone:201-792-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0577941223E0200X
NJ22DI025991001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics