Provider Demographics
NPI:1831484823
Name:AKSHINTHALA, NIRUPAMA B (DMD)
Entity Type:Individual
Prefix:DR
First Name:NIRUPAMA
Middle Name:B
Last Name:AKSHINTHALA
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 1:2501 JESSE WAY
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-6412
Mailing Address - Country:US
Mailing Address - Phone:732-710-2492
Mailing Address - Fax:
Practice Address - Street 1:127 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2475
Practice Address - Country:US
Practice Address - Phone:732-545-7776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI024719001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice