Provider Demographics
NPI:1518581586
Name:DIWAKER, GUNJEETA (DDS)
Entity Type:Individual
Prefix:
First Name:GUNJEETA
Middle Name:
Last Name:DIWAKER
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 1:800 N 8TH ST UNIT 103
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5061
Mailing Address - Country:US
Mailing Address - Phone:669-252-4370
Mailing Address - Fax:
Practice Address - Street 1:5150 GRAVES AVE STE 11-S
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129
Practice Address - Country:US
Practice Address - Phone:669-252-4370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104906122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist