Provider Demographics
NPI:1104044064
Name:PARIKH, ANKUR B (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANKUR
Middle Name:B
Last Name:PARIKH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-5301
Mailing Address - Country:US
Mailing Address - Phone:650-871-2917
Mailing Address - Fax:650-871-7476
Practice Address - Street 1:1490 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-5301
Practice Address - Country:US
Practice Address - Phone:650-871-2917
Practice Address - Fax:650-871-7476
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA481641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB 48164-01OtherHEALTHY FAMALIES
CAG 93508-01OtherDENTICAL