Provider Demographics
NPI:1245760040
Name:SANGADALA, ANUPAMA (DDS)
Entity Type:Individual
Prefix:
First Name:ANUPAMA
Middle Name:
Last Name:SANGADALA
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 1:1630 WEEPING WILLOW CT
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-1320
Mailing Address - Country:US
Mailing Address - Phone:404-909-2678
Mailing Address - Fax:
Practice Address - Street 1:5958 N CANTON CENTER RD STE 400
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187
Practice Address - Country:US
Practice Address - Phone:734-451-9570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022630122300000X
IL019.031329122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist