Healthcare Provider Details

I. General information

NPI: 1679469639
Provider Name (Legal Business Name): PRIYANKA VARAKANTAM DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5651 SNELL AVE
SAN JOSE CA
95123-3328
US

IV. Provider business mailing address

16670 CERRO VISTA DR
MORGAN HILL CA
95037-3905
US

V. Phone/Fax

Practice location:
  • Phone: 408-840-6000
  • Fax:
Mailing address:
  • Phone: 516-972-5472
  • 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. PRIYANKA VARAKANTAM
Title or Position: OWNER/ DENTIST
Credential: DDS
Phone: 516-972-5472