Provider Demographics
NPI:1457638819
Name:MAHAJAN, ANU (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANU
Middle Name:
Last Name:MAHAJAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2836 E DESERT BROOM PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-2468
Mailing Address - Country:US
Mailing Address - Phone:480-940-6659
Mailing Address - Fax:
Practice Address - Street 1:2836 E DESERT BROOM PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-2468
Practice Address - Country:US
Practice Address - Phone:480-940-6659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-12
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0082831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice