Provider Demographics
NPI:1518631258
Name:NAPPOLY, ANJUM (DDS)
Entity Type:Individual
Prefix:
First Name:ANJUM
Middle Name:
Last Name:NAPPOLY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24935 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2811
Mailing Address - Country:US
Mailing Address - Phone:248-403-4004
Mailing Address - Fax:
Practice Address - Street 1:15667 ROY ROGERS DR STE A-101
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-2158
Practice Address - Country:US
Practice Address - Phone:760-843-5824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1064491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty