Provider Demographics
NPI:1316127947
Name:ANIL P PUNJABI, MD, DDS, INC.
Entity type:Organization
Organization Name:ANIL P PUNJABI, MD, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:P
Authorized Official - Last Name:PUNJABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD,DDS
Authorized Official - Phone:909-798-9950
Mailing Address - Street 1:295 TERRACINA BLVD
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4847
Mailing Address - Country:US
Mailing Address - Phone:909-798-9950
Mailing Address - Fax:
Practice Address - Street 1:295 TERRACINA BLVD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4847
Practice Address - Country:US
Practice Address - Phone:909-798-9950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85143261QM2500X, 2086S0122X
CA38217261QS0112X, 1223S0112X
CAA738332082S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
No261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G851430Medicaid
CAG77477Medicare UPIN