Provider Demographics
NPI:1205421559
Name:NANGIA SANKARAN, UDEEKSHA
Entity type:Individual
Prefix:
First Name:UDEEKSHA
Middle Name:
Last Name:NANGIA SANKARAN
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 1:723 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1134
Mailing Address - Country:US
Mailing Address - Phone:510-697-2191
Mailing Address - Fax:
Practice Address - Street 1:450 SUTTER ST RM 2536
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4204
Practice Address - Country:US
Practice Address - Phone:415-948-7905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS102914122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist