Provider Demographics
NPI:1073764676
Name:DESHMUKH, ANURADHA N (BDS,MSD,CAGS)
Entity Type:Individual
Prefix:DR
First Name:ANURADHA
Middle Name:N
Last Name:DESHMUKH
Suffix:
Gender:F
Credentials:BDS,MSD,CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 FULLER ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-1926
Mailing Address - Country:US
Mailing Address - Phone:781-828-2330
Mailing Address - Fax:
Practice Address - Street 1:100 E NEWTON ST
Practice Address - Street 2:BOSTON UNIVERSITY SCHOOL OF DENTAL MEDICINE,G217
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2308
Practice Address - Country:US
Practice Address - Phone:617-638-4762
Practice Address - Fax:617-638-6170
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103641223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics