Provider Demographics
NPI:1144360249
Name:ANUN, SUMANA (DDS)
Entity type:Individual
Prefix:MISS
First Name:SUMANA
Middle Name:
Last Name:ANUN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:SUMANA
Other - Middle Name:
Other - Last Name:ANUNTALABHOCHAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3755 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711
Mailing Address - Country:US
Mailing Address - Phone:909-624-7712
Mailing Address - Fax:907-624-3755
Practice Address - Street 1:5467 MORENO ST
Practice Address - Street 2:SUITE A
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-1682
Practice Address - Country:US
Practice Address - Phone:909-946-6771
Practice Address - Fax:909-946-6831
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38641122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3864101Medicaid