Provider Demographics
NPI:1265270904
Name:SAMRA, ANUKARAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ANUKARAN
Middle Name:
Last Name:SAMRA
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 1:778 CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330
Mailing Address - Country:US
Mailing Address - Phone:510-579-6844
Mailing Address - Fax:
Practice Address - Street 1:612 W 11TH ST STE 201
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3859
Practice Address - Country:US
Practice Address - Phone:209-835-8408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1078531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice