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General NPI Number Information
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NPI Number | 1700289691
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Entity Type | Organization
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Legal Business Name | DR ANANDHI DJEGARADJANE DDS APC
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Dates
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Enumeration Date | 10/06/2014
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Last Update Date | 10/07/2014
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Provider Practice Location Address
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Address Line | 910 WILLOW RD
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City | MENLO PARK
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State | CA
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Zip | 94025-2544
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Country | US
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Telephone | 650-326-3764
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Fax | 650-326-1069
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Provider Business Mailing Address
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Address Line | 910 WILLOW RD
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City | MENLO PARK
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State | CA
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Zip | 94025-2544
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Country | US
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Telephone | 650-326-3764
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Fax | 650-326-1069
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | ANANDHI DJEGARADJANE
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Credential | DDS
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Telephone | 650-326-3764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 47069
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License Number State | CA
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