Provider Demographics
NPI:1730792771
Name:RANJAN, ABHISHEK (DDS)
Entity type:Individual
Prefix:MR
First Name:ABHISHEK
Middle Name:
Last Name:RANJAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 COFFEE RD BLDG B
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1756
Mailing Address - Country:US
Mailing Address - Phone:209-578-3131
Mailing Address - Fax:209-578-3406
Practice Address - Street 1:2801 COFFEE RD BLDG B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1756
Practice Address - Country:US
Practice Address - Phone:209-578-3131
Practice Address - Fax:209-578-3406
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105372521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice