Provider Demographics
NPI:1235463662
Name:BALAKRISHNA, SUSHMA (DDS)
Entity Type:Individual
Prefix:
First Name:SUSHMA
Middle Name:
Last Name:BALAKRISHNA
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 1:3640 FLORIAN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-4161
Mailing Address - Country:US
Mailing Address - Phone:508-847-9501
Mailing Address - Fax:
Practice Address - Street 1:9130 ALCOSTA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3849
Practice Address - Country:US
Practice Address - Phone:925-230-9414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60230122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist