Provider Demographics
NPI:1063171379
Name:SAJI THOMAS, SWETA (DDS)
Entity type:Individual
Prefix:
First Name:SWETA
Middle Name:
Last Name:SAJI THOMAS
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 1:5701 CALLIE LN APT E
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-5013
Mailing Address - Country:US
Mailing Address - Phone:916-507-5040
Mailing Address - Fax:
Practice Address - Street 1:5701 CALLIE LN APT E
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-5013
Practice Address - Country:US
Practice Address - Phone:916-507-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107141122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist