Provider Demographics
NPI:1518121433
Name:THELMA C DAWANA DMD A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:THELMA C DAWANA DMD A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THELMA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAWANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-719-1005
Mailing Address - Street 1:995 MONTAGUE EXPRESSWAY SUITE112
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035
Mailing Address - Country:US
Mailing Address - Phone:408-719-1005
Mailing Address - Fax:408-907-9182
Practice Address - Street 1:995 MONTAGUE EXPRESSWAY SUITE112
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035
Practice Address - Country:US
Practice Address - Phone:408-719-1005
Practice Address - Fax:408-907-9182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty