Healthcare Provider Details

I. General information

NPI: 1912836149
Provider Name (Legal Business Name): ASHOK N VEERANKI DDS INC A PROFESSIONAL DENTAL COORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 NORTHGATE DR STE 200
SAN RAFAEL CA
94903-3666
US

IV. Provider business mailing address

899 NORTHGATE DR STE 200
SAN RAFAEL CA
94903-3666
US

V. Phone/Fax

Practice location:
  • Phone: 628-258-0718
  • Fax: 628-258-0741
Mailing address:
  • Phone: 628-258-0718
  • Fax: 628-258-0741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: JENN HERITAGE
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 402-805-4516