Provider Demographics
NPI:1982752051
Name:ANAND, REENA (DDS)
Entity Type:Individual
Prefix:
First Name:REENA
Middle Name:
Last Name:ANAND
Suffix:
Gender:F
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:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:MAD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95552-0004
Mailing Address - Country:US
Mailing Address - Phone:707-574-6616
Mailing Address - Fax:707-574-6523
Practice Address - Street 1:153-A VAN DUZEN RD
Practice Address - Street 2:
Practice Address - City:MAD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95552
Practice Address - Country:US
Practice Address - Phone:707-574-6616
Practice Address - Fax:707-574-6523
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA508851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice