Provider Demographics
NPI:1215389069
Name:SANJAY KUMAR VANJARAPU DDS PC
Entity Type:Organization
Organization Name:SANJAY KUMAR VANJARAPU DDS PC
Other - Org Name:SMILE DESIGNS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:VANJARAPU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-780-4777
Mailing Address - Street 1:295 SPRECKELS AVE
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-6005
Mailing Address - Country:US
Mailing Address - Phone:209-780-4777
Mailing Address - Fax:209-780-4498
Practice Address - Street 1:295 SPRECKELS AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-6005
Practice Address - Country:US
Practice Address - Phone:209-780-4777
Practice Address - Fax:209-780-4498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55771122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1841362019OtherDENTICAL