Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 172 | OK |
NPI | 1053558254 |
---|---|
Provider Name | Dr. Anaita Nalladaru Mullasseril |
First Address | Shawnee, OK 74804-1317 |
Second Address | Shawnee, OK 74804-1317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2009 |
Last Update Date | 04/07/2012 |