Provider Demographics
NPI:1134385016
Name:WITHANACHCHI, JANATHA (DDS)
Entity type:Individual
Prefix:
First Name:JANATHA
Middle Name:
Last Name:WITHANACHCHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 VALLEY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2825
Mailing Address - Country:US
Mailing Address - Phone:862-250-6952
Mailing Address - Fax:
Practice Address - Street 1:71 VALLEY ST STE 100
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2825
Practice Address - Country:US
Practice Address - Phone:862-250-6952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023987121223E0200X
NY0565081223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics