Provider Demographics
NPI:1659446870
Name:MULCHANDANI, RAMESH (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAMESH
Middle Name:
Last Name:MULCHANDANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:R
Other - Middle Name:M
Other - Last Name:MULCHANDANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:12060 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-2839
Mailing Address - Country:US
Mailing Address - Phone:323-564-4417
Mailing Address - Fax:
Practice Address - Street 1:12060 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-2839
Practice Address - Country:US
Practice Address - Phone:323-564-4417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29388122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB29388-02OtherDENTICAL
CAB29388-01OtherDENTICAL
CAB29388-02OtherDENTICAL
CAD29388Medicare ID - Type UnspecifiedINACTIVE