Provider Demographics
NPI:1578890950
Name:LALWANI, RENUKA DILIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:RENUKA
Middle Name:DILIP
Last Name:LALWANI
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 1:3214 VERNAZZA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1720
Mailing Address - Country:US
Mailing Address - Phone:408-238-8560
Mailing Address - Fax:
Practice Address - Street 1:6134 CAMINO VERDE DR
Practice Address - Street 2:SUITE G
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1431
Practice Address - Country:US
Practice Address - Phone:408-226-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44003122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice