Provider Demographics
NPI:1639730179
Name:VERMA, ANCHAL
Entity Type:Individual
Prefix:
First Name:ANCHAL
Middle Name:
Last Name:VERMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANCHAL
Other - Middle Name:
Other - Last Name:KAPILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4440 S 117TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-2444
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:654 CENTRAL AVE. E.
Practice Address - Street 2:
Practice Address - City:ST. MICHAEL
Practice Address - State:MN
Practice Address - Zip Code:55376
Practice Address - Country:US
Practice Address - Phone:763-703-7529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7576122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist