Provider Demographics
NPI:1689112708
Name:BHERWANI, ANEEL KUMAR (DMD)
Entity type:Individual
Prefix:
First Name:ANEEL
Middle Name:KUMAR
Last Name:BHERWANI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 THUNDER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-1339
Mailing Address - Country:US
Mailing Address - Phone:609-305-1264
Mailing Address - Fax:
Practice Address - Street 1:60 CHURCH ST STE 15
Practice Address - Street 2:
Practice Address - City:YALESVILLE
Practice Address - State:CT
Practice Address - Zip Code:06492-2394
Practice Address - Country:US
Practice Address - Phone:203-774-0019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT123911223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program