Provider Demographics
NPI:1730525650
Name:SAMIR NANJAPA DDS, A DENTAL CORPORATION
Entity type:Organization
Organization Name:SAMIR NANJAPA DDS, A DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:NANJAPA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:650-477-6920
Mailing Address - Street 1:60 BARNESON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2906
Mailing Address - Country:US
Mailing Address - Phone:415-216-5068
Mailing Address - Fax:
Practice Address - Street 1:320 N SAN MATEO DR # 2
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2514
Practice Address - Country:US
Practice Address - Phone:650-477-6920
Practice Address - Fax:650-344-1845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-19
Last Update Date:2013-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty