Provider Demographics
NPI:1780074468
Name:JINJUWADIA, MILAN (BDS,MPH,DDS)
Entity type:Individual
Prefix:
First Name:MILAN
Middle Name:
Last Name:JINJUWADIA
Suffix:
Gender:M
Credentials:BDS,MPH,DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 VALLEY AVE
Mailing Address - Street 2:APT L
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6159
Mailing Address - Country:US
Mailing Address - Phone:205-919-9192
Mailing Address - Fax:
Practice Address - Street 1:2313 N CORRAL HOLLOW RD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-9401
Practice Address - Country:US
Practice Address - Phone:209-371-0710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA643291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice