Provider Demographics
NPI:1740833805
Name:SUCHETA AMANJEE DDS INC
Entity type:Organization
Organization Name:SUCHETA AMANJEE DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUCHETA
Authorized Official - Middle Name:SARATHY
Authorized Official - Last Name:AMANJEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-780-7890
Mailing Address - Street 1:520 COTTONWOOD ST STE 3
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3603
Mailing Address - Country:US
Mailing Address - Phone:530-662-7558
Mailing Address - Fax:530-668-2121
Practice Address - Street 1:520 COTTONWOOD ST STE 3
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3603
Practice Address - Country:US
Practice Address - Phone:530-662-7558
Practice Address - Fax:530-668-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty