Healthcare Provider Details

I. General information

NPI: 1467613927
Provider Name (Legal Business Name): ANEETA PUCHERIL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 YOUNGFIELD ST SUITE 2
LAKEWOOD CO
80215-1045
US

IV. Provider business mailing address

2500 YOUNGFIELD ST SUITE 2
LAKEWOOD CO
80215-1045
US

V. Phone/Fax

Practice location:
  • Phone: 303-237-7004
  • Fax: 303-237-0312
Mailing address:
  • Phone: 303-237-7004
  • Fax: 303-237-0312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8205
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: