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General NPI Number Information
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NPI Number | 1881110369
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Entity Type | Individual
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Provider Name | RADHIKA MISTRY D. D. S.
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Gender | Female
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 330 CRESCENT VILLAGE CIR UNIT 2104
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City | SAN JOSE
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State | CA
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Zip | 95134-3547
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Country | US
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Telephone | 480-522-5733
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Fax |
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Provider Business Mailing Address
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Address Line | 1063 MORSE AVE APT 14-103
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City | SUNNYVALE
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State | CA
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Zip | 94089-1669
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Country | US
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Telephone |
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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 | 101919
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License Number State | CA
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