1871555938 NPI number — ANJULI TINNEMEYER DMD

Table of content: ANJULI TINNEMEYER DMD (NPI 1871555938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871555938 NPI number — ANJULI TINNEMEYER DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TINNEMEYER
Provider First Name:
ANJULI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JAGTIAMI
Provider Other First Name:
ANJULI
Provider Other Middle Name:
MOHAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871555938
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
926 GREAT POND DR
Provider Second Line Business Mailing Address:
SUITE 2003
Provider Business Mailing Address City Name:
ALTAMONTE SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32714-7244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
407-788-3572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1597 WASHINGTON PIKE
Provider Second Line Business Practice Location Address:
SUITE A5
Provider Business Practice Location Address City Name:
BRIDGEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15017-2881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-279-4800
Provider Business Practice Location Address Fax Number:
412-279-7119
Provider Enumeration Date:
04/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DS035203 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0019507770019 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com