Provider Demographics
NPI:1750793345
Name:ANANDA R. MURTHY, DDS, INC.
Entity type:Organization
Organization Name:ANANDA R. MURTHY, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANANDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MURTHY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-424-1441
Mailing Address - Street 1:620 E SAN ANTONIO DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2203
Mailing Address - Country:US
Mailing Address - Phone:562-142-4144
Mailing Address - Fax:562-424-1441
Practice Address - Street 1:620 E SAN ANTONIO DR
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2203
Practice Address - Country:US
Practice Address - Phone:562-142-4144
Practice Address - Fax:562-424-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-30
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28841261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB-28841-01Medicaid