Provider Demographics
NPI:1760128532
Name:MAVANI, TULSI J (DMD)
Entity Type:Individual
Prefix:
First Name:TULSI
Middle Name:J
Last Name:MAVANI
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 1:8777 GRADY DR
Mailing Address - Street 2:
Mailing Address - City:BREINIGSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18031-4106
Mailing Address - Country:US
Mailing Address - Phone:484-358-3499
Mailing Address - Fax:
Practice Address - Street 1:8777 GRADY DR
Practice Address - Street 2:
Practice Address - City:BREINIGSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18031-4106
Practice Address - Country:US
Practice Address - Phone:484-358-3499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043159122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist