Provider Demographics
NPI:1023198710
Name:SANGANEE, SUDHA JITENDRA (DDS)
Entity type:Individual
Prefix:DR
First Name:SUDHA
Middle Name:JITENDRA
Last Name:SANGANEE
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 1:165 E 179TH ST
Mailing Address - Street 2:SUITE: LOBBY- L
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4712
Mailing Address - Country:US
Mailing Address - Phone:718-731-2645
Mailing Address - Fax:718-731-2648
Practice Address - Street 1:165 E 179TH ST
Practice Address - Street 2:SUITE: LOBBY- L
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4712
Practice Address - Country:US
Practice Address - Phone:718-731-2645
Practice Address - Fax:718-731-2648
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0354881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00544110Medicaid
NY9176526OtherDORAL
NY10554-1OtherAMERICHOICE
NY11637928OtherCAQH