Provider Demographics
NPI:1578686838
Name:DIVYA R DOSHI DDS INC
Entity Type:Organization
Organization Name:DIVYA R DOSHI DDS INC
Other - Org Name:MARY DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DIVYA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-739-0093
Mailing Address - Street 1:415 NORTH MARY AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-4189
Mailing Address - Country:US
Mailing Address - Phone:408-739-0093
Mailing Address - Fax:
Practice Address - Street 1:415 N MARY AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4119
Practice Address - Country:US
Practice Address - Phone:408-739-0093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39626261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental