Provider Demographics
NPI:1588878862
Name:KELKAR, DHANANJAY M (DDS)
Entity type:Individual
Prefix:
First Name:DHANANJAY
Middle Name:M
Last Name:KELKAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 GLEN ST
Mailing Address - Street 2:7
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2792
Mailing Address - Country:US
Mailing Address - Phone:516-671-0447
Mailing Address - Fax:516-671-0635
Practice Address - Street 1:37 GLEN ST
Practice Address - Street 2:7
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-5003
Practice Address - Country:US
Practice Address - Phone:516-671-0447
Practice Address - Fax:516-671-0635
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35663122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00600431Medicaid