Healthcare Provider Details

I. General information

NPI: 1821194192
Provider Name (Legal Business Name): ANIL PITAMBER PUNJABI MD, DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 TERRACINA BLVD.
REDLANDS CA
92373
US

IV. Provider business mailing address

295 TERRACINA BLVD.
REDLANDS CA
92373
US

V. Phone/Fax

Practice location:
  • Phone: 909-798-9950
  • Fax: 909-798-9958
Mailing address:
  • Phone: 909-798-9950
  • Fax: 909-798-9958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number38217
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG85143
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number38217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: