Provider Demographics
NPI:1821194192
Name:PUNJABI, ANIL PITAMBER (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:ANIL
Middle Name:PITAMBER
Last Name:PUNJABI
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 TERRACINA BLVD.
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373
Mailing Address - Country:US
Mailing Address - Phone:909-798-9950
Mailing Address - Fax:909-798-9958
Practice Address - Street 1:295 TERRACINA BLVD.
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373
Practice Address - Country:US
Practice Address - Phone:909-798-9950
Practice Address - Fax:909-798-9958
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38217204E00000X, 1223S0112X
CAG85143208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G851430Medicaid
CA00G851430Medicaid
CA00G851431Medicare ID - Type Unspecified