Provider Demographics
NPI:1780024026
Name:SUCHETA AMANJEE DDS INC
Entity Type:Organization
Organization Name:SUCHETA AMANJEE DDS INC
Other - Org Name:TOOTH FAIRY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUCHETA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMANJEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-450-1002
Mailing Address - Street 1:141 PARKER ST STE B
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-3921
Mailing Address - Country:US
Mailing Address - Phone:707-450-1002
Mailing Address - Fax:
Practice Address - Street 1:141 PARKER ST STE B
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-3921
Practice Address - Country:US
Practice Address - Phone:707-450-1002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA535731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty