Provider Demographics
NPI:1194187922
Name:VINITA GOYAL DDS INC
Entity Type:Organization
Organization Name:VINITA GOYAL DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VINITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOYAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-239-0981
Mailing Address - Street 1:5328 MANDERSTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2251
Mailing Address - Country:US
Mailing Address - Phone:607-239-0981
Mailing Address - Fax:
Practice Address - Street 1:5595 WINFIELD BLVD
Practice Address - Street 2:104
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1220
Practice Address - Country:US
Practice Address - Phone:408-629-4595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59491122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty