Provider Demographics
NPI:1790521219
Name:MAJMUNDAR, TIANA KALYAN (DMD)
Entity type:Individual
Prefix:
First Name:TIANA
Middle Name:KALYAN
Last Name:MAJMUNDAR
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 1:108 GREENBROOK CT
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-5213
Mailing Address - Country:US
Mailing Address - Phone:925-549-6991
Mailing Address - Fax:
Practice Address - Street 1:1011 HELEN POWER DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-3507
Practice Address - Country:US
Practice Address - Phone:707-451-8390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist