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General NPI Number Information
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NPI Number | 1407256464
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Entity Type | Individual
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Provider Name | SHYAMA SUBHADARSINI D.D.S., B.D.S.
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Gender | Female
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Dates
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Enumeration Date | 08/27/2014
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Last Update Date | 03/30/2022
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Provider Practice Location Address
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Address Line | 4155 MOORPARK AVE STE 17
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City | SAN JOSE
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State | CA
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Zip | 95117-1714
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Country | US
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Telephone | 408-249-7762
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Fax |
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Provider Business Mailing Address
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Address Line | 4155 MOORPARK AVE STE 17
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City | SAN JOSE
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State | CA
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Zip | 95117-1714
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Country | US
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Telephone | 408-249-7762
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 63873
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 63873
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License Number State | CA
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