Healthcare Provider Details

I. General information

NPI: 1356955728
Provider Name (Legal Business Name): ANNA GAZU DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 MAIN AVE
CLIFTON NJ
07011
US

IV. Provider business mailing address

411 E MOUNT PLEASANT AVENUE
LIVINGSTON NJ
07039
US

V. Phone/Fax

Practice location:
  • Phone: 973-577-5700
  • Fax: 862-227-4079
Mailing address:
  • Phone: 732-318-7122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MRS. MANDEEP JOSAN
Title or Position: MANAGER
Credential:
Phone: 732-318-7122