Mukkara Hagerstown LLC
Dentist, Orthodontics and Dentofacial Orthopedics in Hagerstown, MD. Organization (NPI-2).
NPI number1164094330
StatusActive
Last updated in NPPESJul 15, 2021
Details
- NPI
- 1164094330
- Entity type
- Organization (NPI-2)
- Legal business name
- Mukkara Hagerstown LLC
- Organization subpart
- No
- Enumeration date
- Jul 15, 2021
- Certification date
- Jul 15, 2021
- Last updated
- Jul 15, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223X0400X | Dentist, Orthodontics and Dentofacial Orthopedics | – | – | Yes |
Practice location
322 E Antietam St Ste 103Hagerstown, MD 21740-5736
Phone 301-733-1552 · Fax 301-733-1553
Mailing address
7 Kilglass Ct Apt 102Lutherville Timonium, MD 21093-7782
Phone 617-480-2348
Authorized official
Mamata Mukkara
Orthodontist
6174802348
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