Provider Demographics
NPI:1922339340
Name:PURI, SHIKHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHIKHA
Middle Name:
Last Name:PURI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 WOODSIDE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3402
Mailing Address - Country:US
Mailing Address - Phone:512-964-2501
Mailing Address - Fax:
Practice Address - Street 1:1690 WOODSIDE RD STE 204
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3402
Practice Address - Country:US
Practice Address - Phone:512-964-2501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA589511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice