Provider Demographics
NPI:1083756944
Name:DORLIKAR, UJJWALA (DDS)
Entity Type:Individual
Prefix:DR
First Name:UJJWALA
Middle Name:
Last Name:DORLIKAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 STIMSON WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1132
Mailing Address - Country:US
Mailing Address - Phone:408-455-3788
Mailing Address - Fax:
Practice Address - Street 1:3151 S WHITE RD STE 204
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-4045
Practice Address - Country:US
Practice Address - Phone:408-270-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA548651223G0001X
CA54865122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD54865Medicaid