=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689383325
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR NIRMALA RAMS DENTAL OFFICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2022
-----------------------------------------------------
Last Update Date | 11/22/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3280 W GRANT LINE RD STE G
-----------------------------------------------------
City | TRACY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95304-8427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-829-7234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 673 W JARDIN TER
-----------------------------------------------------
City | MOUNTAIN HOUSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95391-1320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-829-7234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MRS. NIRMALA RAMACHANDRAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 408-829-7234
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------