Provider Demographics
NPI:1700211935
Name:DR.ANU DESHPANDE BDS DMD MS PA
Entity Type:Organization
Organization Name:DR.ANU DESHPANDE BDS DMD MS PA
Other - Org Name:PRISTINE ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNAPURNA
Authorized Official - Middle Name:SRIDHER
Authorized Official - Last Name:DESHPANDE
Authorized Official - Suffix:
Authorized Official - Credentials:BDS DMD MS
Authorized Official - Phone:703-899-2996
Mailing Address - Street 1:96 WILLARD ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-7991
Mailing Address - Country:US
Mailing Address - Phone:321-208-7979
Mailing Address - Fax:
Practice Address - Street 1:96 WILLARD ST
Practice Address - Street 2:SUITE 103
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7991
Practice Address - Country:US
Practice Address - Phone:321-208-7979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN189461223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty