Provider Demographics
NPI:1124232053
Name:KHANDWALA, SMITA J (DDS)
Entity Type:Individual
Prefix:DR
First Name:SMITA
Middle Name:J
Last Name:KHANDWALA
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 1:2856 ARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-1374
Mailing Address - Country:US
Mailing Address - Phone:916-481-7617
Mailing Address - Fax:916-481-7403
Practice Address - Street 1:2856 ARDEN WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-1374
Practice Address - Country:US
Practice Address - Phone:916-481-7617
Practice Address - Fax:916-481-7403
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice