Healthcare Provider Details

I. General information

NPI: 1679842728
Provider Name (Legal Business Name): ANUJA WAGH RDH, BS, BDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W BALTIMORE ST ROOM 4214, 4TH FLOOR
BALTIMORE MD
21201-1510
US

IV. Provider business mailing address

650 W BALTIMORE ST ROOM 4214, 4TH FLOOR
BALTIMORE MD
21201-1510
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-7152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number6151
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: