Provider Demographics
NPI:1639932569
Name:DASARI, DEEPIKA
Entity Type:Individual
Prefix:DR
First Name:DEEPIKA
Middle Name:
Last Name:DASARI
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 1:37660 BLACOW RD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-7018
Mailing Address - Country:US
Mailing Address - Phone:650-799-9471
Mailing Address - Fax:
Practice Address - Street 1:37660 BLACOW RD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-7018
Practice Address - Country:US
Practice Address - Phone:650-799-9471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1064891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice