Provider Demographics
NPI:1578970380
Name:SANGHVI, AANYA VIRENDRA (DMD)
Entity Type:Individual
Prefix:
First Name:AANYA
Middle Name:VIRENDRA
Last Name:SANGHVI
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 1:3101 W INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-4035
Mailing Address - Country:US
Mailing Address - Phone:602-861-3333
Mailing Address - Fax:602-682-7733
Practice Address - Street 1:3101 W INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-4035
Practice Address - Country:US
Practice Address - Phone:602-861-3333
Practice Address - Fax:602-682-7733
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD89361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ000000OtherMEDICAID ID IN PROCESS AS OF JULY 14, 2014