Provider Demographics
NPI:1821341934
Name:DARMAWAN, META INDRAJANTI (DDS)
Entity Type:Individual
Prefix:MRS
First Name:META
Middle Name:INDRAJANTI
Last Name:DARMAWAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6273 MISSION ST #200
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014
Mailing Address - Country:US
Mailing Address - Phone:650-991-7300
Mailing Address - Fax:650-756-0966
Practice Address - Street 1:6273 MISSION ST #200
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014
Practice Address - Country:US
Practice Address - Phone:650-991-7300
Practice Address - Fax:650-756-0966
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA37094122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist