Healthcare Provider Details

I. General information

NPI: 1770045601
Provider Name (Legal Business Name): ANAND JETHANI DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 DURANT AVE
BERKELEY CA
94704-1607
US

IV. Provider business mailing address

2300 DURANT AVE
BERKELEY CA
94704-1607
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-4732
  • Fax: 510-848-4846
Mailing address:
  • Phone: 510-848-4732
  • Fax: 510-848-4846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RAJIV JOGINDER ANAND
Title or Position: CEO DENTIST
Credential: DDS
Phone: 415-892-6901