Provider Demographics
NPI:1932667367
Name:GURJAR, DHRUVA ATUL
Entity Type:Individual
Prefix:
First Name:DHRUVA ATUL
Middle Name:
Last Name:GURJAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 MONROE ST APT 417
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-7769
Mailing Address - Country:US
Mailing Address - Phone:424-324-4599
Mailing Address - Fax:
Practice Address - Street 1:4321 COLLINGTON RD STE 210
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-2263
Practice Address - Country:US
Practice Address - Phone:301-809-0029
Practice Address - Fax:301-809-0894
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD167321223G0001X
CA105716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice