Healthcare Provider Details

I. General information

NPI: 1144696410
Provider Name (Legal Business Name): HARI PRIYA ANNE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6502 GRAPE RD STE 882
MISHAWAKA IN
46545-1102
US

IV. Provider business mailing address

14821 FAIRFIELD DR
GRANGER IN
46530-7397
US

V. Phone/Fax

Practice location:
  • Phone: 574-345-0345
  • Fax: 574-345-0344
Mailing address:
  • Phone: 419-819-0335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12012608A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: