Healthcare Provider Details

I. General information

NPI: 1306086186
Provider Name (Legal Business Name): ANAND MAHARATHI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ANAND MAHARATHI DMD

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 THE ALAMEDA
BERKELEY CA
94709-1907
US

IV. Provider business mailing address

1206 THE ALAMEDA
BERKELEY CA
94709-1907
US

V. Phone/Fax

Practice location:
  • Phone: 510-525-7521
  • Fax: 510-525-5262
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number58119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: