Provider Demographics
NPI:1760032007
Name:VIJAY MUNAGALA DDS INC
Entity Type:Organization
Organization Name:VIJAY MUNAGALA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNAGALA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-886-6416
Mailing Address - Street 1:2245 TAHITI DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-1432
Mailing Address - Country:US
Mailing Address - Phone:240-529-5987
Mailing Address - Fax:
Practice Address - Street 1:20212 REDWOOD RD STE 101
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4324
Practice Address - Country:US
Practice Address - Phone:510-886-6416
Practice Address - Fax:510-886-4827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental