Provider Demographics
NPI:1164894606
Name:WILLOWOOD FAMILY DENTAL CARE P.C.
Entity Type:Organization
Organization Name:WILLOWOOD FAMILY DENTAL CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANURADHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GANTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-222-8485
Mailing Address - Street 1:185 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19054-3116
Mailing Address - Country:US
Mailing Address - Phone:215-943-4484
Mailing Address - Fax:267-580-0199
Practice Address - Street 1:185 WILLOW DR
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19054-3116
Practice Address - Country:US
Practice Address - Phone:215-943-4484
Practice Address - Fax:267-580-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0375621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty