Provider Demographics
NPI:1720116114
Name:FALDU, MITESH GIRISH (DMD)
Entity Type:Individual
Prefix:DR
First Name:MITESH
Middle Name:GIRISH
Last Name:FALDU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 IRON BRIDGE RD
Mailing Address - Street 2:SUITE #14
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2975
Mailing Address - Country:US
Mailing Address - Phone:732-409-0090
Mailing Address - Fax:
Practice Address - Street 1:555 IRON BRIDGE RD
Practice Address - Street 2:SUITE #14
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2975
Practice Address - Country:US
Practice Address - Phone:732-409-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI019382001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics