Provider Demographics
NPI:1558374215
Name:BRAHME, ANITA NANDA (DDS, MDS)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:NANDA
Last Name:BRAHME
Suffix:
Gender:F
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6086 SUNNY CREST DR
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377
Mailing Address - Country:US
Mailing Address - Phone:818-991-3561
Mailing Address - Fax:
Practice Address - Street 1:355 CENTRAL AVE
Practice Address - Street 2:CLINICAS DEL CAMINO REAL, INC
Practice Address - City:FILLMORE
Practice Address - State:CA
Practice Address - Zip Code:93015
Practice Address - Country:US
Practice Address - Phone:805-524-4926
Practice Address - Fax:805-524-4137
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA474551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice