Provider Demographics
NPI:1871153460
Name:AMARNATH, ANEESHA RAO (DMD)
Entity type:Individual
Prefix:DR
First Name:ANEESHA
Middle Name:RAO
Last Name:AMARNATH
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 1:10894 DRYDEN AVE
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-4746
Mailing Address - Country:US
Mailing Address - Phone:408-309-4007
Mailing Address - Fax:
Practice Address - Street 1:10393 TORRE AVE #L
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014
Practice Address - Country:US
Practice Address - Phone:408-446-4353
Practice Address - Fax:408-446-4951
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1058511223P0221X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry