Healthcare Provider Details

I. General information

NPI: 1457732513
Provider Name (Legal Business Name): ANA GHIBU D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8162 E SANTA ANA CANYON RD STE 104
ANAHEIM CA
92808-1154
US

IV. Provider business mailing address

5005 STATE RD
ASHTABULA OH
44004-6265
US

V. Phone/Fax

Practice location:
  • Phone: 714-202-0765
  • Fax:
Mailing address:
  • Phone: 440-992-3146
  • Fax: 440-998-6932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30-024521
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number103607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: