Provider Demographics
NPI:1982811725
Name:TANTRA DJAYA D.D.S INC.
Entity Type:Organization
Organization Name:TANTRA DJAYA D.D.S INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TANTRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DJAYA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-945-9493
Mailing Address - Street 1:9316 PAINTER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-2727
Mailing Address - Country:US
Mailing Address - Phone:562-945-9493
Mailing Address - Fax:562-693-8781
Practice Address - Street 1:9316 PAINTER AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-2727
Practice Address - Country:US
Practice Address - Phone:562-945-9493
Practice Address - Fax:562-639-8781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA969806OtherUNITED CONCORDIA PROVIDER
CAB33277-01OtherDENTICAL