Healthcare Provider Details

I. General information

NPI: 1811075153
Provider Name (Legal Business Name): ANURADHA GADE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10827 NORTHRIDGE SQ
CUPERTINO CA
95014-0525
US

IV. Provider business mailing address

10827 NORTHRIDGE SQ
CUPERTINO CA
95014-0525
US

V. Phone/Fax

Practice location:
  • Phone: 469-879-8931
  • Fax:
Mailing address:
  • Phone: 469-879-8931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22979
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number60993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: