Organization
MUKKARA FREDERICK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAMATA MUKKARA DMD, CAGS, DSCD (ORTHODONTIST)
(617) 480-2348
Entity
Organization
Contact information
Practice address
198 THOMAS JOHNSON DR STE 204, FREDERICK, MD 21702-4464
(301) 620-9666
Mailing address
7 KILGLASS CT APT 102, LUTHERVILLE TIMONIUM, MD 21093-7782
(617) 480-2348
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
07/15/2021
Last updated
07/15/2021
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