Provider Demographics
NPI:1336209626
Name:VADERHOBLI, SUPRIYA KUMAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUPRIYA
Middle Name:KUMAR
Last Name:VADERHOBLI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SUPRIYA
Other - Middle Name:
Other - Last Name:KUMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:331 INVERNESS DR
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1712
Mailing Address - Country:US
Mailing Address - Phone:650-359-1062
Mailing Address - Fax:
Practice Address - Street 1:331 INVERNESS DR
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-1712
Practice Address - Country:US
Practice Address - Phone:650-359-1062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50769122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist