Provider Demographics
NPI:1336523935
Name:TANDON, SHRUTI (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHRUTI
Middle Name:
Last Name:TANDON
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 1:34641 WINSLOW TER
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-3643
Mailing Address - Country:US
Mailing Address - Phone:919-272-3480
Mailing Address - Fax:
Practice Address - Street 1:255 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-6503
Practice Address - Country:US
Practice Address - Phone:919-272-3480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040537122300000X
CADDS101952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist