Healthcare Provider Details

I. General information

NPI: 1134805856
Provider Name (Legal Business Name): JAANU GULRAJANI DENTIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43531 10TH ST W
LANCASTER CA
93534-6005
US

IV. Provider business mailing address

43531 10TH ST W
LANCASTER CA
93534-6005
US

V. Phone/Fax

Practice location:
  • Phone: 661-839-7630
  • Fax:
Mailing address:
  • Phone: 661-839-7630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113466
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: