Provider Demographics
NPI:1699457457
Name:GHODEKAR, ANUJA (DDS)
Entity type:Individual
Prefix:DR
First Name:ANUJA
Middle Name:
Last Name:GHODEKAR
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 1:117 FOUNTAIN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-2711
Mailing Address - Country:US
Mailing Address - Phone:617-961-2253
Mailing Address - Fax:
Practice Address - Street 1:126 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-5048
Practice Address - Country:US
Practice Address - Phone:978-912-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18599131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice