MEDICARE: VASANTH DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1346997707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VASANTH DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	15 EL CAMINO REAL
Second Line	:
City	:	MILLBRAE
State	:	CA
Zip	:	94030-2603
Country	:	US
Telephone Number	:	650-697-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 EL CAMINO REAL
Second Line	:
City	:	MILLBRAE
State	:	CA
Zip	:	94030-2603
Country	:	US
Telephone Number	:	650-697-9000
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. SUPRIYA SURAJ VASANTH
Credential	:	DMD
Telephone Number	:	650-697-9000

Provider Enumeration Date	:	03/06/2022
Last Update Date	:	03/06/2022

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Directions to “VASANTH DENTAL CORPORATION ” Practice Location

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