Provider Demographics
NPI:1457480295
Name:MISHRA, RANU M (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:RANU
Middle Name:M
Last Name:MISHRA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:177 W EL PORTAL DR
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2847
Mailing Address - Country:US
Mailing Address - Phone:209-383-9222
Mailing Address - Fax:209-383-5372
Practice Address - Street 1:177 W EL PORTAL DR
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2847
Practice Address - Country:US
Practice Address - Phone:209-383-9222
Practice Address - Fax:209-383-5372
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51823332BC3200X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment