Provider Demographics
NPI:1336377571
Name:MOHINDRA, ANKUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANKUR
Middle Name:
Last Name:MOHINDRA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 ARTESIA BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-2985
Mailing Address - Country:US
Mailing Address - Phone:310-303-7930
Mailing Address - Fax:310-303-7938
Practice Address - Street 1:1951 ARTESIA BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-2985
Practice Address - Country:US
Practice Address - Phone:310-303-7930
Practice Address - Fax:310-303-7938
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52434122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist