Provider Demographics
NPI:1568737062
Name:SURTI, MOULI (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOULI
Middle Name:
Last Name:SURTI
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 1:55 RIVERWALK PLACE
Mailing Address - Street 2:APT 703
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093
Mailing Address - Country:US
Mailing Address - Phone:908-686-2082
Mailing Address - Fax:
Practice Address - Street 1:381 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-9430
Practice Address - Country:US
Practice Address - Phone:908-686-2082
Practice Address - Fax:908-686-2149
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025413001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry