| NPI | 1487190906 |
|---|---|
| Former Name | ANUSHA GANTA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 32839) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02659900) |
| Enumeration Date | 2017-01-07 |
| Last Update Date | 2018-03-17 |