Provider Demographics
NPI:1962506006
Name:DJEGARADJANE, ANANDHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANANDHI
Middle Name:
Last Name:DJEGARADJANE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 WILLOW ROAD
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025
Mailing Address - Country:US
Mailing Address - Phone:650-326-3764
Mailing Address - Fax:650-326-1069
Practice Address - Street 1:910 WILLOW ROAD
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025
Practice Address - Country:US
Practice Address - Phone:650-326-3764
Practice Address - Fax:650-326-1069
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47069122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9378801OtherMEDICAL DENTI CAL