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General NPI Number Information
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NPI Number | 1558899872
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Entity Type | Organization
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Legal Business Name | ISHAAN TALWAR, DDS, INC
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 05/31/2017
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Provider Practice Location Address
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Address Line | 3000 ALAMO DR STE 202
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City | VACAVILLE
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State | CA
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Zip | 95687-6352
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Country | US
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Telephone | 925-482-7757
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Fax |
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Provider Business Mailing Address
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Address Line | 1122 DANILO CT
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City | MANTECA
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State | CA
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Zip | 95337-8768
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Country | US
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Telephone | 925-482-7757
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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. ISHAAN TALWAR
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Credential | DDS
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Telephone | 925-482-7757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 64204
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License Number State | CA
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