Provider Demographics
NPI:1508805425
Name:ANANTHANARAYANAN, DEEPA (DMD)
Entity Type:Individual
Prefix:
First Name:DEEPA
Middle Name:
Last Name:ANANTHANARAYANAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BUCKLIN RD
Mailing Address - Street 2:
Mailing Address - City:N ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5928
Mailing Address - Country:US
Mailing Address - Phone:603-772-4352
Mailing Address - Fax:603-772-5086
Practice Address - Street 1:19 HAMPTON RD
Practice Address - Street 2:SUITE #1
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4816
Practice Address - Country:US
Practice Address - Phone:603-772-4352
Practice Address - Fax:603-772-5086
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH31981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice