Provider Demographics
NPI:1659453801
Name:KAMLESH JINJUWADIA DDS INC
Entity Type:Organization
Organization Name:KAMLESH JINJUWADIA DDS INC
Other - Org Name:EAST BAY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMLESH
Authorized Official - Middle Name:R
Authorized Official - Last Name:JINJUWADIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-796-1499
Mailing Address - Street 1:3500 MOWRY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1409
Mailing Address - Country:US
Mailing Address - Phone:510-796-1499
Mailing Address - Fax:
Practice Address - Street 1:3500 MOWRY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1409
Practice Address - Country:US
Practice Address - Phone:510-796-1499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty