Dr. Adelheid Nerisa Limansubroto, DDS
Dentist, Endodontics in Visalia, CA. Individual provider (NPI-1).
NPI number1134737836
StatusActive
Last updated in NPPESJul 19, 2020
Details
- NPI
- 1134737836
- Entity type
- Individual (NPI-1)
- Name
- Dr. Adelheid Nerisa Limansubroto
- Credential
- DDS
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jul 19, 2020
- Certification date
- Jul 19, 2020
- Last updated
- Jul 19, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223E0200X | Dentist, Endodontics | 104987 | CA | Yes |
Practice location
1104 N Chinowth StVisalia, CA 93291-4113
Phone 559-625-9043
Mailing address
2857 S Lovers Ln Apt EVisalia, CA 93292-3385
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- Alan Sproles, DDSNPI 1083865745
All 7 Endodontics providers in Visalia · All 5,100 providers in Visalia
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