Provider Demographics
NPI:1659486249
Name:MUDDASANI, PADMINI R (DDS, MS)
Entity type:Individual
Prefix:
First Name:PADMINI
Middle Name:R
Last Name:MUDDASANI
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 HWY K
Mailing Address - Street 2:
Mailing Address - City:O'FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368
Mailing Address - Country:US
Mailing Address - Phone:636-978-8381
Mailing Address - Fax:636-272-2377
Practice Address - Street 1:2410 HWY K
Practice Address - Street 2:
Practice Address - City:O'FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368
Practice Address - Country:US
Practice Address - Phone:636-978-8381
Practice Address - Fax:636-272-2377
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE0158831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics