Healthcare Provider Details

I. General information

NPI: 1699610717
Provider Name (Legal Business Name): ANUSHA JAIN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989375 NEBRASKA MED CENTER
OMAHA NE
68198-9375
US

IV. Provider business mailing address

11895 LEXINGTON WOODS DR
JOHNS CREEK GA
30005-6754
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-6000
  • Fax:
Mailing address:
  • Phone: 678-760-9498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8234
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: