Healthcare Provider Details

I. General information

NPI: 1235773508
Provider Name (Legal Business Name): DHANASHRI NANDAVIKAR, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2669A CROPLEY AVE
SAN JOSE CA
95132-3707
US

IV. Provider business mailing address

784 NODAWAY AVE
FREMONT CA
94539-7544
US

V. Phone/Fax

Practice location:
  • Phone: 408-942-0469
  • Fax:
Mailing address:
  • Phone: 650-215-3058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DHANASHRI NANDAVIKAR
Title or Position: CEO
Credential:
Phone: 650-215-3058