Healthcare Provider Details

I. General information

NPI: 1013115070
Provider Name (Legal Business Name): ANKUR JOHRI DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 S CEDAR CREST BLVD SUITE 311
ALLENTOWN PA
18103-6205
US

IV. Provider business mailing address

1251 S CEDAR CREST BLVD SUITE 311
ALLENTOWN PA
18103-6205
US

V. Phone/Fax

Practice location:
  • Phone: 610-821-9588
  • Fax:
Mailing address:
  • Phone: 610-435-6161
  • Fax: 610-435-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDS-038193
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: