Provider Demographics
NPI:1366920662
Name:KHERDE, SNEHA VIJAY
Entity type:Individual
Prefix:
First Name:SNEHA
Middle Name:VIJAY
Last Name:KHERDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 KING AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-1514
Mailing Address - Country:US
Mailing Address - Phone:408-930-2226
Mailing Address - Fax:
Practice Address - Street 1:2140 S SHORE CTR
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-8043
Practice Address - Country:US
Practice Address - Phone:510-214-0253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist