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General NPI Number Information
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NPI Number | 1912057456
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Entity Type | Individual
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Provider Name | SANGEETHA NEDUNCHEZHIAN DDS
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Gender | Female
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 01/14/2014
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Provider Practice Location Address
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Address Line | 307 PARKER ST
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City | VACAVILLE
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State | CA
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Zip | 95688-4513
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Country | US
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Telephone | 707-448-2134
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Fax | 707-448-5423
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Provider Business Mailing Address
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Address Line | 250 FRUITVALE RD
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City | VACAVILLE
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State | CA
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Zip | 95688-2746
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Country | US
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Telephone | 925-360-1311
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Fax | 707-448-5423
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 49612
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License Number State | CA
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