Provider Demographics
NPI:1720236631
Name:MARINGANTI, RENUKA (DDS)
Entity Type:Individual
Prefix:DR
First Name:RENUKA
Middle Name:
Last Name:MARINGANTI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:RENUKA
Other - Middle Name:
Other - Last Name:MARINGANTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1 N WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1875
Mailing Address - Country:US
Mailing Address - Phone:609-567-0434
Mailing Address - Fax:609-567-1169
Practice Address - Street 1:600 PEMBERTON BROWNS MILLS RD
Practice Address - Street 2:
Practice Address - City:PEMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08068
Practice Address - Country:US
Practice Address - Phone:609-894-1100
Practice Address - Fax:609-894-1110
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0381321223G0001X
NJ22DI023867001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice