Provider Demographics
NPI:1558430207
Name:NANJAPA, SAMIR (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:
Last Name:NANJAPA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BARNESON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2906
Mailing Address - Country:US
Mailing Address - Phone:415-216-5068
Mailing Address - Fax:
Practice Address - Street 1:1528 S EL CAMINO REAL
Practice Address - Street 2:SUITE 408
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3060
Practice Address - Country:US
Practice Address - Phone:650-477-6920
Practice Address - Fax:650-212-3505
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2013-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190263231223P0700X
CA558401223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics