Healthcare Provider Details

I. General information

NPI: 1265118152
Provider Name (Legal Business Name): JANANI THIRUVENGADAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14807 W 64TH AVE UNIT C
ARVADA CO
80007-0104
US

IV. Provider business mailing address

2600 S ROCK CREEK PKWY APT 41-102
SUPERIOR CO
80027-4581
US

V. Phone/Fax

Practice location:
  • Phone: 303-456-4095
  • Fax:
Mailing address:
  • Phone: 516-655-0108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN.00206428
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: