Provider Demographics
NPI:1245380286
Name:MADHAV, ANITA NAIK (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:NAIK
Last Name:MADHAV
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 1:7600 SAN JACINTO PLACE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3237
Mailing Address - Country:US
Mailing Address - Phone:972-618-1111
Mailing Address - Fax:972-767-3757
Practice Address - Street 1:7600 SAN JACINTO PLACE
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3237
Practice Address - Country:US
Practice Address - Phone:972-618-1111
Practice Address - Fax:972-767-3757
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX192711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice