Healthcare Provider Details

I. General information

NPI: 1225386576
Provider Name (Legal Business Name): ANITA NEELA RATHOD DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANITA NEELA BHAVNANI DMD, MS

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 YORBA RANCH ROAD STE. A
YORBA LINDA CA
92887
US

IV. Provider business mailing address

4915 YORBA RANCH ROAD STE. A
YORBA LINDA CA
92887
US

V. Phone/Fax

Practice location:
  • Phone: 714-777-4080
  • Fax:
Mailing address:
  • Phone: 714-777-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number60897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: