Healthcare Provider Details

I. General information

NPI: 1962506006
Provider Name (Legal Business Name): ANANDHI DJEGARADJANE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 WILLOW ROAD
MENLO PARK CA
94025
US

IV. Provider business mailing address

910 WILLOW ROAD
MENLO PARK CA
94025
US

V. Phone/Fax

Practice location:
  • Phone: 650-326-3764
  • Fax: 650-326-1069
Mailing address:
  • Phone: 650-326-3764
  • Fax: 650-326-1069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number47069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: