Provider Demographics
NPI:1770138968
Name:SANJAY KUMAR VANJARAPU DDS PC
Entity type:Organization
Organization Name:SANJAY KUMAR VANJARAPU DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:VANJARAPU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-780-4777
Mailing Address - Street 1:6280 W LAS POSITAS BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-4940
Mailing Address - Country:US
Mailing Address - Phone:925-234-4421
Mailing Address - Fax:925-237-9019
Practice Address - Street 1:6280 W LAS POSITAS BLVD STE 215
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-4940
Practice Address - Country:US
Practice Address - Phone:925-234-4421
Practice Address - Fax:925-237-9019
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANJAY KUMAR VANJARAPU DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1215389069Medicaid