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General NPI Number Information
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NPI Number | 1760032007
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Entity Type | Organization
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Legal Business Name | VIJAY MUNAGALA DDS INC
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 09/18/2019
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Provider Practice Location Address
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Address Line | 20212 REDWOOD RD STE 101
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-4324
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Country | US
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Telephone | 510-886-6416
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Fax | 510-886-4827
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Provider Business Mailing Address
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Address Line | 2245 TAHITI DR
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City | SAN RAMON
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State | CA
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Zip | 94582-1432
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Country | US
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Telephone | 240-529-5987
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. VIJAY MUNAGALA
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Credential | DDS
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Telephone | 510-886-6416
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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 |
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License Number State |
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