Provider Demographics
NPI:1073689725
Name:GOWDA, ANJANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANJANA
Middle Name:
Last Name:GOWDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-2061
Mailing Address - Country:US
Mailing Address - Phone:862-251-1976
Mailing Address - Fax:
Practice Address - Street 1:145 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-5338
Practice Address - Country:US
Practice Address - Phone:732-229-3698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0363591223G0001X
NJ22DI022794001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101210506Medicaid
NJ0423254Medicaid