Provider Demographics
NPI:1396408845
Name:DHANNY, ARJUN
Entity Type:Individual
Prefix:
First Name:ARJUN
Middle Name:
Last Name:DHANNY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 E WASHINGTON AVE APT 809
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-4414
Mailing Address - Country:US
Mailing Address - Phone:618-614-0812
Mailing Address - Fax:
Practice Address - Street 1:1853 NORTHPORT DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3027
Practice Address - Country:US
Practice Address - Phone:608-422-4746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002713-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice