Healthcare Provider Details

I. General information

NPI: 1649767385
Provider Name (Legal Business Name): UJJWALA DORLIKAR DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 S WHITE RD STE 204
SAN JOSE CA
95148-4045
US

IV. Provider business mailing address

3230 STIMSON WAY
SAN JOSE CA
95135-1132
US

V. Phone/Fax

Practice location:
  • Phone: 408-270-1120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberCA54865
License Number StateCA

VIII. Authorized Official

Name: DR. UJJWALA DORLIKAR
Title or Position: CEO
Credential: DDS
Phone: 408-455-3788