Provider Demographics
NPI:1912057456
Name:NEDUNCHEZHIAN, SANGEETHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANGEETHA
Middle Name:
Last Name:NEDUNCHEZHIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 FRUITVALE RD
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-2746
Mailing Address - Country:US
Mailing Address - Phone:925-360-1311
Mailing Address - Fax:707-448-5423
Practice Address - Street 1:307 PARKER ST
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4513
Practice Address - Country:US
Practice Address - Phone:707-448-2134
Practice Address - Fax:707-448-5423
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA496121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice