Provider Demographics
NPI:1528114063
Name:SALES, ANNA IDA (DMD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:IDA
Last Name:SALES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8583 MAHOGANY PL
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-3346
Mailing Address - Country:US
Mailing Address - Phone:510-742-0220
Mailing Address - Fax:510-742-2497
Practice Address - Street 1:6189 JARVIS AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-1210
Practice Address - Country:US
Practice Address - Phone:510-742-0220
Practice Address - Fax:510-742-2497
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA481761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice