Healthcare Provider Details

I. General information

NPI: 1750793345
Provider Name (Legal Business Name): ANANDA R. MURTHY, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2014
Last Update Date: 05/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 E SAN ANTONIO DR
LONG BEACH CA
90807-2203
US

IV. Provider business mailing address

620 E SAN ANTONIO DR
LONG BEACH CA
90807-2203
US

V. Phone/Fax

Practice location:
  • Phone: 562-142-4144
  • Fax: 562-424-1441
Mailing address:
  • Phone: 562-142-4144
  • Fax: 562-424-1441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number28841
License Number StateCA

VIII. Authorized Official

Name: DR. ANANDA R. MURTHY
Title or Position: OWNER
Credential: DDS
Phone: 562-424-1441