Provider Demographics
NPI:1437599263
Name:DIVAKARAN, DHANYA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:DHANYA
Middle Name:A
Last Name:DIVAKARAN
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 1:21223 COTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-3332
Mailing Address - Country:US
Mailing Address - Phone:909-327-1582
Mailing Address - Fax:
Practice Address - Street 1:717 N PLACENTIA AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3289
Practice Address - Country:US
Practice Address - Phone:714-577-0105
Practice Address - Fax:714-577-0506
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA594961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice