Individual
PRAVEENA MUDDANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8241 S HOWELL AVE, SUITE 100, OAK CREEK, WI 53154-8346
(414) 762-5200
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189
(315) 464-6000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6931-15
WI
Other
Enumeration date
06/19/2012
Last updated
06/19/2012
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