Organization
ARROWHEAD COMMUNITY SURGICAL MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
APPANAGARI GNANADEV MD. (PRESIDENT)
(909) 580-6210
Entity
Organization
Contact information
Practice address
400 N PEPPER AVE, SURGERY DEPARTMENT, COLTON, CA 92324-1801
(909) 580-6210
(909) 580-1363
Mailing address
PO BOX 670, REDLANDS, CA 92373-0221
(909) 580-6210
(909) 580-1363
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
51201
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00SP18300
—
CA
05
—
GR0079700
—
CA
Enumeration date
01/08/2007
Last updated
08/22/2020
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