Provider Demographics
NPI:1104278837
Name:YADAV, VARUN (DMD)
Entity type:Individual
Prefix:DR
First Name:VARUN
Middle Name:
Last Name:YADAV
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 SOUTH MATHILDA AVENUE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086
Mailing Address - Country:US
Mailing Address - Phone:408-732-7982
Mailing Address - Fax:408-732-4190
Practice Address - Street 1:5677 GIBRALTAR DRIVE STE B
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588
Practice Address - Country:US
Practice Address - Phone:925-225-9855
Practice Address - Fax:925-225-9865
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101672122300000X
CADDS1016721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice