Provider Demographics
NPI:1588354161
Name:YADAV, ANJU (DMD)
Entity type:Individual
Prefix:
First Name:ANJU
Middle Name:
Last Name:YADAV
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-1628
Mailing Address - Country:US
Mailing Address - Phone:312-964-2811
Mailing Address - Fax:
Practice Address - Street 1:4244 FERNE BLVD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-3809
Practice Address - Country:US
Practice Address - Phone:610-259-6619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS044183122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist