Provider Demographics
NPI:1053161844
Name:ANUKARAN SAMRA DDS INC
Entity type:Organization
Organization Name:ANUKARAN SAMRA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANUKARAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-579-6844
Mailing Address - Street 1:778 CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330
Mailing Address - Country:US
Mailing Address - Phone:510-579-6844
Mailing Address - Fax:
Practice Address - Street 1:612 W 11TH ST STE 201
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3859
Practice Address - Country:US
Practice Address - Phone:209-835-8408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental