Individual
DR. MAMATA MUKKARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD, DSCD, CAGS
Contact information
Practice address
5632 THE ALAMEDA, BALTIMORE, MD 21239-2737
(617) 480-2348
Mailing address
2221 E BIJOU ST STE 100, COLORADO SPRINGS, CO 80909-8009
(719) 576-1850
(719) 955-3470
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
15876
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
091615433
—
DC
05
—
109820900
—
MD
Enumeration date
01/02/2007
Last updated
06/14/2019
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