Provider Demographics
NPI:1316483803
Name:ANISHA RANCHHOD DDS, INC.
Entity type:Organization
Organization Name:ANISHA RANCHHOD DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANISHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RANCHHOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD, FAACP
Authorized Official - Phone:209-333-0374
Mailing Address - Street 1:1300 W LODI AVE
Mailing Address - Street 2:SUITE M
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-3000
Mailing Address - Country:US
Mailing Address - Phone:209-333-0374
Mailing Address - Fax:209-333-0732
Practice Address - Street 1:1300 W LODI AVE
Practice Address - Street 2:SUITE M
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3000
Practice Address - Country:US
Practice Address - Phone:209-333-0374
Practice Address - Fax:209-333-0732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55990261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental