Provider Demographics
NPI:1548600844
Name:GODARA, VANILA (DDS)
Entity type:Individual
Prefix:DR
First Name:VANILA
Middle Name:
Last Name:GODARA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:VANILA
Other - Middle Name:
Other - Last Name:CHOUDHRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2500 ALTON PKWY STE 202&208
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5024
Mailing Address - Country:US
Mailing Address - Phone:714-557-7744
Mailing Address - Fax:714-540-5718
Practice Address - Street 1:2500 ALTON PKWY
Practice Address - Street 2:STE 202 & 208
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5034
Practice Address - Country:US
Practice Address - Phone:714-557-7744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS103737122300000X, 1223S0112X
WADE60390138122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist