Provider Demographics
NPI:1356955728
Name:ANNA GAZU DDS PA
Entity type:Organization
Organization Name:ANNA GAZU DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-318-7122
Mailing Address - Street 1:411 E MOUNT PLEASANT AVENUE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:732-318-7122
Mailing Address - Fax:
Practice Address - Street 1:1113 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011
Practice Address - Country:US
Practice Address - Phone:973-577-5700
Practice Address - Fax:862-227-4079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty