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General NPI Number Information
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NPI Number | 1386032407
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Entity Type | Organization
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Legal Business Name | VIKRAM R. TIKU, DDS, INC.
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Dates
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Enumeration Date | 12/23/2014
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Last Update Date | 12/23/2014
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Provider Practice Location Address
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Address Line | 3221 S HIGUERA ST
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-6924
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Country | US
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Telephone | 805-544-8111
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Fax |
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Provider Business Mailing Address
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Address Line | 3221 S HIGUERA ST
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-6924
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Country | US
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Telephone | 805-544-8111
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. VIKRAM RAJ TIKU
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Credential | DDS
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Telephone | 805-544-8111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 63318
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License Number State | CA
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