Provider Demographics
NPI:1770667016
Name:JOG, ANAGHA B (DMD, DDS)
Entity Type:Individual
Prefix:DR
First Name:ANAGHA
Middle Name:B
Last Name:JOG
Suffix:
Gender:F
Credentials:DMD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 WALSH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-0956
Mailing Address - Country:US
Mailing Address - Phone:408-987-0530
Mailing Address - Fax:408-988-0955
Practice Address - Street 1:2727 WALSH AVE STE 102
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-0956
Practice Address - Country:US
Practice Address - Phone:408-987-0530
Practice Address - Fax:408-988-0955
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-029944-L1223G0001X
CA447071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA44707OtherDENTAL BOARD OF CALIFORNIA
CA1538378575OtherGROUP NPI
CA1538378575OtherGROUP NPI
CA44707OtherDENTAL BOARD OF CALIFORNIA