Provider Demographics
NPI:1154568111
Name:PIMPLE, ARCHANA SANJIV (DDS)
Entity type:Individual
Prefix:DR
First Name:ARCHANA
Middle Name:SANJIV
Last Name:PIMPLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14591 NEWPORT AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6026
Mailing Address - Country:US
Mailing Address - Phone:714-832-8420
Mailing Address - Fax:
Practice Address - Street 1:14591 NEWPORT AVE STE 104
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6026
Practice Address - Country:US
Practice Address - Phone:714-832-8420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice