Provider Demographics
NPI:1427034966
Name:ARDESHNA, ANIL PURSHOTAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANIL
Middle Name:PURSHOTAM
Last Name:ARDESHNA
Suffix:
Gender:M
Credentials:DMD
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Other - Credentials:
Mailing Address - Street 1:110 BERGEN STREET, ROOM 712C
Mailing Address - Street 2:UMDNJ-NEW JERSEY DENTAL
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103
Mailing Address - Country:US
Mailing Address - Phone:973-972-1892
Mailing Address - Fax:973-972-0526
Practice Address - Street 1:110 BERGEN STREET
Practice Address - Street 2:UMDNJ-NEW JERSEY DENTAL SCHOOL- ROOM
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2495
Practice Address - Country:US
Practice Address - Phone:973-972-4729
Practice Address - Fax:973-972-0526
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2008-11-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJDI017837001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics