Provider Demographics
NPI:1609232651
Name:UPADHYAY, NAMRATA JAIMAN
Entity Type:Individual
Prefix:
First Name:NAMRATA
Middle Name:JAIMAN
Last Name:UPADHYAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 JACKLIN RD
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-3426
Mailing Address - Country:US
Mailing Address - Phone:408-719-1197
Mailing Address - Fax:
Practice Address - Street 1:1303 JACKLIN RD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-3426
Practice Address - Country:US
Practice Address - Phone:408-719-1197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65203122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist