MEDICARE: DR. YOGITA THAKUR DDS

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	1223D0001X	Public Health Dentistry	57319	CA
2	1223P0221X	Pediatric Dentistry	57319	CA

General Provider Information

NPI Number	:	1821300138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YOGITA THAKUR DDS

Provider Business Mailing Address
First Line	:	1807 BAY RD
Second Line	:
City	:	EAST PALO ALTO
State	:	CA
Zip	:	94303-1312
Country	:	US
Telephone Number	:	650-289-7710
Fax Number	:	650-853-1018

Provider Business Practice Location Address
First Line	:	1807 BAY RD.
Second Line	:
City	:	E PALO ALTO
State	:	CA
Zip	:	94303-1312
Country	:	US
Telephone Number	:	650-289-7710
Fax Number	:	650-853-1018

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

Provider Enumeration Date	:	07/02/2010
Last Update Date	:	12/08/2015

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