Provider Demographics
NPI:1457045833
Name:TUNGARE, SUJATA
Entity Type:Individual
Prefix:
First Name:SUJATA
Middle Name:
Last Name:TUNGARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7350 GALLAGHER DR APT 259
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-3161
Mailing Address - Country:US
Mailing Address - Phone:315-480-7548
Mailing Address - Fax:
Practice Address - Street 1:7500 42ND AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55427-1225
Practice Address - Country:US
Practice Address - Phone:763-252-6350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14905122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist