Healthcare Provider Details

I. General information

NPI: 1982906160
Provider Name (Legal Business Name): ANUSHIA SIVENDRAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2010
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 LAKE VIEW DR
GETTYSBURG PA
17325-8431
US

IV. Provider business mailing address

88 LAKE VIEW DR
GETTYSBURG PA
17325-8431
US

V. Phone/Fax

Practice location:
  • Phone: 717-873-3949
  • Fax:
Mailing address:
  • Phone: 717-873-3949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS038238
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: