Provider Demographics
NPI:1457734931
Name:BOMMU, ANUSHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANUSHA
Middle Name:
Last Name:BOMMU
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 1:3233 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-3031
Mailing Address - Country:US
Mailing Address - Phone:717-757-0468
Mailing Address - Fax:717-757-0681
Practice Address - Street 1:1509 CEDAR CLIFF DR
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-7720
Practice Address - Country:US
Practice Address - Phone:571-385-6646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0405231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice