Provider Demographics
NPI:1497232672
Name:BHASKAR, VAISHNAVI (DDS)
Entity Type:Individual
Prefix:DR
First Name:VAISHNAVI
Middle Name:
Last Name:BHASKAR
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 1:1615 PALA RANCH CIR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-0901
Mailing Address - Country:US
Mailing Address - Phone:408-386-0995
Mailing Address - Fax:
Practice Address - Street 1:6323 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-3713
Practice Address - Country:US
Practice Address - Phone:408-386-0995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1027211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice