Provider Demographics
NPI:1770914236
Name:KAMLESH JINJUWADIA D.D.S., INC
Entity type:Organization
Organization Name:KAMLESH JINJUWADIA D.D.S., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMLESH
Authorized Official - Middle Name:R
Authorized Official - Last Name:JINJUWADIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-523-3450
Mailing Address - Street 1:1807 SANTA RITA RD STE C
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4744
Mailing Address - Country:US
Mailing Address - Phone:925-523-3450
Mailing Address - Fax:925-523-3440
Practice Address - Street 1:1807 SANTA RITA RD STE C
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4744
Practice Address - Country:US
Practice Address - Phone:925-523-3450
Practice Address - Fax:925-523-3440
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTBAY DENTAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty