Healthcare Provider Details

I. General information

NPI: 1912246364
Provider Name (Legal Business Name): LISA VACHHARAJANI BUDA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA ANNETTE BUDA DDS

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 LAUREL ST SUITE 310
SAN FRANCISCO CA
94118-1980
US

IV. Provider business mailing address

390 LAUREL ST SUITE 310
SAN FRANCISCO CA
94118-1980
US

V. Phone/Fax

Practice location:
  • Phone: 415-563-4261
  • Fax: 415-563-4269
Mailing address:
  • Phone: 415-563-4261
  • Fax: 415-563-4269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number056520
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number62803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: