Provider Demographics
NPI:1649767385
Name:UJJWALA DORLIKAR DDS INC
Entity Type:Organization
Organization Name:UJJWALA DORLIKAR DDS INC
Other - Org Name:EVERGREEN FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:UJJWALA
Authorized Official - Middle Name:
Authorized Official - Last Name:DORLIKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-455-3788
Mailing Address - Street 1:3230 STIMSON WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3151 S WHITE RD STE 204
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-4045
Practice Address - Country:US
Practice Address - Phone:408-270-1120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA548651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty