Provider Demographics
NPI:1386004497
Name:ANU RAJASEKARAN, DMD.PC.
Entity Type:Organization
Organization Name:ANU RAJASEKARAN, DMD.PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANU
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAJASEKARAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:858-755-7474
Mailing Address - Street 1:12068 DAYMARK CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3801
Mailing Address - Country:US
Mailing Address - Phone:858-449-2255
Mailing Address - Fax:
Practice Address - Street 1:12630 MONTE VISTA RD STE 103
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2526
Practice Address - Country:US
Practice Address - Phone:858-755-7474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA45313122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty