Provider Demographics
NPI:1487063111
Name:MOHAN, ANU (DDS)
Entity type:Individual
Prefix:
First Name:ANU
Middle Name:
Last Name:MOHAN
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 1:3790 VIA DE LA VALLE #208
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-4250
Mailing Address - Country:US
Mailing Address - Phone:858-465-8717
Mailing Address - Fax:
Practice Address - Street 1:3790 VIA DE LA VALLE #208
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-4250
Practice Address - Country:US
Practice Address - Phone:858-367-9717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63659122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist