Provider Demographics
NPI:1003342007
Name:BRINDHA SUBRAMANIAN, BDS MS DENTAL CORPORATION
Entity Type:Organization
Organization Name:BRINDHA SUBRAMANIAN, BDS MS DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRINDHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBRAMANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, MS
Authorized Official - Phone:504-952-6169
Mailing Address - Street 1:991 SARATOGA AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-2357
Mailing Address - Country:US
Mailing Address - Phone:408-692-5437
Mailing Address - Fax:408-498-7737
Practice Address - Street 1:991 SARATOGA AVE
Practice Address - Street 2:STE 220
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-2357
Practice Address - Country:US
Practice Address - Phone:408-692-5437
Practice Address - Fax:408-498-7737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58339261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental