Provider Demographics
NPI:1790845444
Name:MAHAJAN, ANIL K (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANIL
Middle Name:K
Last Name:MAHAJAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ANIL
Other - Middle Name:K
Other - Last Name:MAHAJAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:815 W HOLT BLVD STE 402
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3681
Mailing Address - Country:US
Mailing Address - Phone:909-635-0444
Mailing Address - Fax:909-635-0448
Practice Address - Street 1:815 W HOLT BLVD STE 402
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3681
Practice Address - Country:US
Practice Address - Phone:909-635-0444
Practice Address - Fax:909-635-0448
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11931122300000X
CA58280122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist