Provider Demographics
NPI:1003824913
Name:BALMURI, SUDHAKER RAO (DDS)
Entity type:Individual
Prefix:
First Name:SUDHAKER
Middle Name:RAO
Last Name:BALMURI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:SUDHAKER
Other - Middle Name:RAO
Other - Last Name:BALMURI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:343 PARK AVE
Mailing Address - Street 2:SUITE A5
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017
Mailing Address - Country:US
Mailing Address - Phone:973-414-8500
Mailing Address - Fax:973-414-8500
Practice Address - Street 1:343 PARK AVE
Practice Address - Street 2:SUITE A5
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017
Practice Address - Country:US
Practice Address - Phone:973-414-8500
Practice Address - Fax:973-414-8500
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ17979122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1740345693Other741 BROADWAY
NJ6130801Medicaid
NJ1194996645Other444 WILLIAMS ST
NJ1972778413OtherIRVINGTON
NJ1932370483Other101 LUDLOW
NJ1972778413OtherIRVINGTON