Healthcare Provider Details

I. General information

NPI: 1730525650
Provider Name (Legal Business Name): SAMIR NANJAPA DDS, A DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2013
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 S EL CAMINO REAL STE 408
SAN MATEO CA
94402-3067
US

IV. Provider business mailing address

1528 S EL CAMINO REAL STE 408
SAN MATEO CA
94402-3067
US

V. Phone/Fax

Practice location:
  • Phone: 650-212-3500
  • Fax: 650-212-3505
Mailing address:
  • Phone: 415-212-3500
  • Fax: 650-212-3505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMIR NANJAPA
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 650-212-3500