Healthcare Provider Details

I. General information

NPI: 1790845444
Provider Name (Legal Business Name): ANIL K MAHAJAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ANIL K MAHAJAN DDS

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8787 HALL RD
LAMONT CA
93241-1953
US

IV. Provider business mailing address

8787 HALL RD
LAMONT CA
93241-1953
US

V. Phone/Fax

Practice location:
  • Phone: 661-845-3688
  • Fax: 661-845-3739
Mailing address:
  • Phone: 661-845-3688
  • Fax: 661-845-3739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD11931
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number58280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: