Provider Demographics
NPI:1265830103
Name:BANSAL, SEEMA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEEMA
Middle Name:
Last Name:BANSAL
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 1:7174 SANTA TERESA BLVD.
Mailing Address - Street 2:ST A-4
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95139
Mailing Address - Country:US
Mailing Address - Phone:408-225-2201
Mailing Address - Fax:408-225-2206
Practice Address - Street 1:7174 SANTA TERESA BLVD.
Practice Address - Street 2:ST - A-4
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95139
Practice Address - Country:US
Practice Address - Phone:408-225-2201
Practice Address - Fax:408-225-2206
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46554122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist