Provider Demographics
NPI:1497043459
Name:BANERJEE, ANJALI ANAND (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANJALI
Middle Name:ANAND
Last Name:BANERJEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ANJALI
Other - Middle Name:ARVIND
Other - Last Name:PANDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BDS
Mailing Address - Street 1:191 CONCORD CT
Mailing Address - Street 2:
Mailing Address - City:BEACON FALLS
Mailing Address - State:CT
Mailing Address - Zip Code:06403-4924
Mailing Address - Country:US
Mailing Address - Phone:203-723-2748
Mailing Address - Fax:
Practice Address - Street 1:1131 TOLLAND TPKE
Practice Address - Street 2:SUITE J
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-1679
Practice Address - Country:US
Practice Address - Phone:860-533-7270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0105501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice