Individual
DR. ANU NELLISSERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DS040300
PA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
12312
CT
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
DS040300
PA
Other
Enumeration date
03/17/2015
Last updated
08/31/2021
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