Basic Information
Provider Information
NPI: 1477619674
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: THANIK
FirstName: GITANJALI
MiddleName: PURI
NamePrefix: DR.
NameSuffix:  
Credential: D.D.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11995 SW IBIS TER
Address2:  
City: BEAVERTON
State: OR
PostalCode: 970077257
CountryCode: US
TelephoneNumber: 5035790490
FaxNumber:  
Practice Location
Address1: 6950 NE CAMPUS WAY
Address2:  
City: HILLSBORO
State: OR
PostalCode: 971245611
CountryCode: US
TelephoneNumber: 5039522164
FaxNumber: 5035264418
Other Information
ProviderEnumerationDate: 12/29/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000XD7847ORY Dental ProvidersDentist 

No ID Information.


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