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General NPI Number Information
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NPI Number | 1194187922
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Entity Type | Organization
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Legal Business Name | VINITA GOYAL DDS INC
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 5595 WINFIELD BLVD 104
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City | SAN JOSE
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State | CA
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Zip | 95123-1220
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Country | US
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Telephone | 408-629-4595
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Fax |
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Provider Business Mailing Address
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Address Line | 5328 MANDERSTON DR
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City | SAN JOSE
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State | CA
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Zip | 95138-2251
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Country | US
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Telephone | 607-239-0981
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | VINITA GOYAL
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Credential |
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Telephone | 607-239-0981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 59491
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License Number State | CA
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