Provider Demographics
NPI:1992242994
Name:SANGHA, HENNA
Entity type:Individual
Prefix:
First Name:HENNA
Middle Name:
Last Name:SANGHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 S SCATTERFIELD RD # 2
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-5766
Mailing Address - Country:US
Mailing Address - Phone:260-399-1333
Mailing Address - Fax:
Practice Address - Street 1:1537 S SCATTERFIELD RD # 2
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-5766
Practice Address - Country:US
Practice Address - Phone:260-399-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012639A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12012639AOtherSTATE OF INDIANA LICENSE