Provider Demographics
NPI:1164942645
Name:ASHOK N VEERANKI DDS INC A PROFESSIONAL DENTAL COORPORATION
Entity Type:Organization
Organization Name:ASHOK N VEERANKI DDS INC A PROFESSIONAL DENTAL COORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-823-9371
Mailing Address - Street 1:620 W EATON AVE
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3361
Mailing Address - Country:US
Mailing Address - Phone:209-823-9371
Mailing Address - Fax:209-823-8374
Practice Address - Street 1:620 W EATON AVE
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3361
Practice Address - Country:US
Practice Address - Phone:209-823-9371
Practice Address - Fax:209-823-8374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA515261223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty