Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DS042062 | PA |
NPI | 1033562129 |
---|---|
Provider Name | Anjali Nanda |
First Address | Farmington, CT 06032-3082 |
Second Address | Farmington, CT 06030-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2016 |
Last Update Date | 05/01/2021 |