Provider Demographics
NPI:1225515372
Name:SAXENA, PRIYANKA (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRIYANKA
Middle Name:
Last Name:SAXENA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:PRIYANKA
Other - Middle Name:ASHWINIKUMAR
Other - Last Name:SRIVASTAVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BDS
Mailing Address - Street 1:1416 CONSTANSO WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-4904
Mailing Address - Country:US
Mailing Address - Phone:408-771-5136
Mailing Address - Fax:
Practice Address - Street 1:730 STORY RD STE 5
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-2624
Practice Address - Country:US
Practice Address - Phone:408-771-5136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-22
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102823122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist