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General NPI Number Information
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NPI Number | 1265016265
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Entity Type | Organization
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Legal Business Name | MOHANA AWASTHI,DDS, INC.
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Dates
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Enumeration Date | 05/06/2021
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Last Update Date | 05/06/2021
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Provider Practice Location Address
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Address Line | 1588 SOQUEL DR STE 3
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1714
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Country | US
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Telephone | 831-454-8120
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Fax |
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Provider Business Mailing Address
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Address Line | 17535 SODA SPRINGS RD
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City | LOS GATOS
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State | CA
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Zip | 95033-8653
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Country | US
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Telephone | 774-208-3880
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MOHANA RATNA SHILPA AWASTHI
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Credential | DDS
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Telephone | 774-208-3880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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