Provider Demographics
NPI:1033427232
Name:GRINBERG AHANI, ANNA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:GRINBERG AHANI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12395 EL CAMINO REAL STE 312
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3085
Mailing Address - Country:US
Mailing Address - Phone:858-259-0331
Mailing Address - Fax:
Practice Address - Street 1:12395 EL CAMINO REAL STE 312
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3085
Practice Address - Country:US
Practice Address - Phone:858-259-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0389411223G0001X
CADDS1013101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral Practice