Provider Demographics
NPI:1649573858
Name:MUGHNI, ANJUM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANJUM
Middle Name:
Last Name:MUGHNI
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 1:12666 MASON FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7453
Mailing Address - Country:US
Mailing Address - Phone:314-628-0107
Mailing Address - Fax:314-628-0107
Practice Address - Street 1:777 S NEW BALLAS RD STE 217E
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-8718
Practice Address - Country:US
Practice Address - Phone:314-432-0900
Practice Address - Fax:314-432-0900
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2010-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004001684122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist