Provider Demographics
NPI:1043323850
Name:TONNU, AN (DMD)
Entity Type:Individual
Prefix:DR
First Name:AN
Middle Name:
Last Name:TONNU
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 1:5150 GRAVES AVE STE 12C
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-5015
Mailing Address - Country:US
Mailing Address - Phone:408-252-8860
Mailing Address - Fax:408-521-0142
Practice Address - Street 1:5150 GRAVES AVE STE 12C
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-5015
Practice Address - Country:US
Practice Address - Phone:408-252-8860
Practice Address - Fax:408-521-0142
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48152122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist