MEDICARE: MISS SUMANA ANUN 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	122300000X	Dentist	38641	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144360249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SUMANA ANUN DDS

Provider Business Mailing Address
First Line	:	3755 N GRAND AVE
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711
Country	:	US
Telephone Number	:	909-624-7712
Fax Number	:	907-624-3755

Provider Business Practice Location Address
First Line	:	5467 MORENO ST
Second Line	:	SUITE A
City	:	MONTCLAIR
State	:	CA
Zip	:	91763-1682
Country	:	US
Telephone Number	:	909-946-6771
Fax Number	:	909-946-6831

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/08/2007

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