MEDICARE: APURVA SHREEKANT DABAK

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	109222	CA

General Provider Information

NPI Number	:	1710764204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	APURVA SHREEKANT DABAK

Provider Business Mailing Address
First Line	:	1030 HARNESS DR APT 56
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-2256
Country	:	US
Telephone Number	:	650-820-0337
Fax Number	:

Provider Business Practice Location Address
First Line	:	93 ARCH ST
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94062-1401
Country	:	US
Telephone Number	:	650-820-0337
Fax Number	:	650-779-0101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2023
Last Update Date	:	06/02/2025

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