Provider Demographics
NPI:1720425127
Name:VIJU, BEENAKUMARI (DDS)
Entity Type:Individual
Prefix:DR
First Name:BEENAKUMARI
Middle Name:
Last Name:VIJU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 GRAND CONCOURSE
Mailing Address - Street 2:SUITE 1-K
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1247
Mailing Address - Country:US
Mailing Address - Phone:718-933-5510
Mailing Address - Fax:718-933-7128
Practice Address - Street 1:3201 GRAND CONCOURSE
Practice Address - Street 2:SUITE I-K
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1247
Practice Address - Country:US
Practice Address - Phone:718-933-5510
Practice Address - Fax:718-933-7128
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-27
Last Update Date:2013-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049274122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist