Provider Demographics
NPI:1659686715
Name:KUMAR, YASHODHARA (DMD)
Entity Type:Individual
Prefix:
First Name:YASHODHARA
Middle Name:
Last Name:KUMAR
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 1:1103 W SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6915
Mailing Address - Country:US
Mailing Address - Phone:856-692-5533
Mailing Address - Fax:856-692-8197
Practice Address - Street 1:1103 W SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6915
Practice Address - Country:US
Practice Address - Phone:856-692-5533
Practice Address - Fax:856-692-8197
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO24445001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice