MEDICARE: DR. SABINE ANITA PURPS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	247157	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	330954348	OTHER	CA	TAX IDENTIFICATION

General Provider Information

NPI Number	:	1053521013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SABINE ANITA PURPS DDS

Provider Business Mailing Address
First Line	:	1764 SAN DIEGO AVE
Second Line	:	#130
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-1987
Country	:	US
Telephone Number	:	619-295-6500
Fax Number	:	619-295-6509

Provider Business Practice Location Address
First Line	:	1764 SAN DIEGO AVE
Second Line	:	#130
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-1987
Country	:	US
Telephone Number	:	619-295-6500
Fax Number	:	619-295-6509

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	05/20/2011

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