1720236631 NPI number — DR. RENUKA MARINGANTI DDS

Table of content: DR. RENUKA MARINGANTI DDS (NPI 1720236631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720236631 NPI number — DR. RENUKA MARINGANTI DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARINGANTI
Provider First Name:
RENUKA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARINGANTI
Provider Other First Name:
RENUKA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1720236631
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 N WHITE HORSE PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMMONTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08037-1875
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-567-0434
Provider Business Mailing Address Fax Number:
609-567-1169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 PEMBERTON BROWNS MILLS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBERTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-894-1100
Provider Business Practice Location Address Fax Number:
609-894-1110
Provider Enumeration Date:
09/04/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DS038132 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 22DI02386700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)