Provider Demographics
NPI:1841362019
Name:VANJARAPU, SANJAY KUMAR (DDS)
Entity type:Individual
Prefix:
First Name:SANJAY
Middle Name:KUMAR
Last Name:VANJARAPU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13899 HIGHWAY 13 S
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2135
Mailing Address - Country:US
Mailing Address - Phone:952-440-2292
Mailing Address - Fax:952-440-2935
Practice Address - Street 1:195 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55309-9572
Practice Address - Country:US
Practice Address - Phone:763-263-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND122101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice