Individual
ANISHA CHANDRAMOULI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5597 TULIP ST STE B4, PHILADELPHIA, PA 19124-1562
(215) 288-8008
Mailing address
210 LOCUST ST APT 14F, PHILADELPHIA, PA 19106-3924
(412) 209-9661
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS043781
PA
Other
Enumeration date
07/15/2022
Last updated
07/15/2022
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