Provider Demographics
NPI:1295040392
Name:JADHAV, ANIKET BHASKAR (DDS, MDS)
Entity Type:Individual
Prefix:
First Name:ANIKET
Middle Name:BHASKAR
Last Name:JADHAV
Suffix:
Gender:M
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4939 TURNER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5925
Mailing Address - Country:US
Mailing Address - Phone:904-302-4852
Mailing Address - Fax:
Practice Address - Street 1:520 N 12TH ST # 315
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5064
Practice Address - Country:US
Practice Address - Phone:804-828-1778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29671122300000X, 1223X0008X
VA04014162781223X0008X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology