1720236631 NPI number — DR. RENUKA MARINGANTI DDS

Table of Contents

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)