Healthcare Provider Details

I. General information

NPI: 1164358974
Provider Name (Legal Business Name): NORTHRIDGE ANISH PURI DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18546 ROSCOE BLVD STE 230
NORTHRIDGE CA
91324-5459
US

IV. Provider business mailing address

1091 CORTE BARROSO
CAMARILLO CA
93010-7438
US

V. Phone/Fax

Practice location:
  • Phone: 805-312-1754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANISH PURI
Title or Position: OWNER
Credential: DDS
Phone: 805-312-1754