Provider Demographics
NPI:1790845444
Name:MAHAJAN, ANIL K (DDS)
Entity type:Individual
Prefix:DR
First Name:ANIL
Middle Name:K
Last Name:MAHAJAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ANIL
Other - Middle Name:K
Other - Last Name:MAHAJAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:8787 HALL RD
Mailing Address - Street 2:
Mailing Address - City:LAMONT
Mailing Address - State:CA
Mailing Address - Zip Code:93241-1953
Mailing Address - Country:US
Mailing Address - Phone:661-845-3688
Mailing Address - Fax:661-845-3739
Practice Address - Street 1:8787 HALL RD
Practice Address - Street 2:
Practice Address - City:LAMONT
Practice Address - State:CA
Practice Address - Zip Code:93241-1953
Practice Address - Country:US
Practice Address - Phone:661-845-3688
Practice Address - Fax:661-845-3739
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11931122300000X
CA58280122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist