Healthcare Provider Details

I. General information

NPI: 1548600844
Provider Name (Legal Business Name): VANILA GODARA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VANILA CHOUDHRY DDS

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ALTON PKWY STE 202 & 208
IRVINE CA
92606-5034
US

IV. Provider business mailing address

2500 ALTON PKWY STE 202&208
IRVINE CA
92606-5024
US

V. Phone/Fax

Practice location:
  • Phone: 714-557-7744
  • Fax:
Mailing address:
  • Phone: 714-557-7744
  • Fax: 714-540-5718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS103737
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60390138
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDDS103737
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: