Provider Demographics
NPI:1912647629
Name:SHYAMA SUBHADARSINI DDS INC
Entity Type:Organization
Organization Name:SHYAMA SUBHADARSINI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHYAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBHADARSINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-249-7762
Mailing Address - Street 1:4155 MOORPARK AVE STE 17
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1714
Mailing Address - Country:US
Mailing Address - Phone:408-249-7762
Mailing Address - Fax:408-249-7764
Practice Address - Street 1:4155 MOORPARK AVE STE 17
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1714
Practice Address - Country:US
Practice Address - Phone:408-249-7762
Practice Address - Fax:408-249-7764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental