Provider Demographics
NPI:1700289691
Name:DR ANANDHI DJEGARADJANE DDS APC
Entity Type:Organization
Organization Name:DR ANANDHI DJEGARADJANE DDS APC
Other - Org Name:WILLOW FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANANDHI
Authorized Official - Middle Name:
Authorized Official - Last Name:DJEGARADJANE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-326-3764
Mailing Address - Street 1:910 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-2544
Mailing Address - Country:US
Mailing Address - Phone:650-326-3764
Mailing Address - Fax:650-326-1069
Practice Address - Street 1:910 WILLOW RD
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-2544
Practice Address - Country:US
Practice Address - Phone:650-326-3764
Practice Address - Fax:650-326-1069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA470691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty