Provider Demographics
NPI:1952630022
Name:BANDI, MALLIKA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MALLIKA
Middle Name:
Last Name:BANDI
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 1:117 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-1803
Mailing Address - Country:US
Mailing Address - Phone:973-340-1066
Mailing Address - Fax:973-340-1103
Practice Address - Street 1:117 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-1803
Practice Address - Country:US
Practice Address - Phone:973-340-1066
Practice Address - Fax:973-340-1103
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI0242281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice