Provider Demographics
NPI:1053558254
Name:MULLASSERIL, ANAITA NALLADARU (BDS, MS)
Entity type:Individual
Prefix:DR
First Name:ANAITA
Middle Name:NALLADARU
Last Name:MULLASSERIL
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Gender:F
Credentials:BDS, MS
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Mailing Address - Street 1:504 SHAWNEE MALL DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1317
Mailing Address - Country:US
Mailing Address - Phone:405-878-8899
Mailing Address - Fax:405-878-8896
Practice Address - Street 1:504 SHAWNEE MALL DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1317
Practice Address - Country:US
Practice Address - Phone:405-878-8899
Practice Address - Fax:405-878-8896
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-10
Last Update Date:2012-07-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK1721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics