Provider Demographics
NPI:1912246364
Name:BUDA, LISA VACHHARAJANI (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:VACHHARAJANI
Last Name:BUDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANNETTE
Other - Last Name:BUDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:390 LAUREL ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1980
Mailing Address - Country:US
Mailing Address - Phone:415-563-4261
Mailing Address - Fax:415-563-4269
Practice Address - Street 1:390 LAUREL ST
Practice Address - Street 2:SUITE 310
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1980
Practice Address - Country:US
Practice Address - Phone:415-563-4261
Practice Address - Fax:415-563-4269
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056520122300000X
CA62803122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist