Provider Demographics
NPI:1366588071
Name:MASHRU, POONAM P (DDS)
Entity type:Individual
Prefix:DR
First Name:POONAM
Middle Name:P
Last Name:MASHRU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 HADDONFIELD BERLIN ROAD
Mailing Address - Street 2:UNIT B
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043
Mailing Address - Country:US
Mailing Address - Phone:856-309-2244
Mailing Address - Fax:856-309-2247
Practice Address - Street 1:6200 MAIN ST
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4629
Practice Address - Country:US
Practice Address - Phone:856-751-6546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2015-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023263001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice