Provider Demographics
NPI:1386706273
Name:JADHAV, MEGHA RAJA (DMD)
Entity type:Individual
Prefix:DR
First Name:MEGHA
Middle Name:RAJA
Last Name:JADHAV
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 PENNSYLVANIA AVE
Mailing Address - Street 2:B2
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3690
Mailing Address - Country:US
Mailing Address - Phone:707-427-3111
Mailing Address - Fax:707-427-3893
Practice Address - Street 1:1900 PENNSYLVANIA AVE
Practice Address - Street 2:B2
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3690
Practice Address - Country:US
Practice Address - Phone:707-427-3111
Practice Address - Fax:707-427-3893
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA577441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice