Provider Demographics
NPI:1699810325
Name:DJAYA, TANTRA (DDS)
Entity Type:Individual
Prefix:
First Name:TANTRA
Middle Name:
Last Name:DJAYA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:TANTRA
Other - Middle Name:
Other - Last Name:DJAYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:9316 PAINTER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-2727
Mailing Address - Country:US
Mailing Address - Phone:562-945-9493
Mailing Address - Fax:562-693-8781
Practice Address - Street 1:9316 PAINTER AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-2727
Practice Address - Country:US
Practice Address - Phone:562-945-9493
Practice Address - Fax:562-693-8781
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33277122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD33277OtherDENTICAL
CA969806OtherUNITED CONCORDIA