Healthcare Provider Details

I. General information

NPI: 1821300138
Provider Name (Legal Business Name): YOGITA THAKUR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YOGITA BUTANI DDS

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 BAY RD.
E PALO ALTO CA
94303-1312
US

IV. Provider business mailing address

1807 BAY RD
EAST PALO ALTO CA
94303-1312
US

V. Phone/Fax

Practice location:
  • Phone: 650-289-7710
  • Fax: 650-853-1018
Mailing address:
  • Phone: 650-289-7710
  • Fax: 650-853-1018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number57319
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number57319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: