Provider Demographics
NPI:1407367824
Name:DR. JOTSNA'S DENTAL OFFICE
Entity type:Organization
Organization Name:DR. JOTSNA'S DENTAL OFFICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:JOTSNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GANGADHARAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-523-2100
Mailing Address - Street 1:3848 MCHENRY AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-1599
Mailing Address - Country:US
Mailing Address - Phone:209-523-2100
Mailing Address - Fax:209-523-2101
Practice Address - Street 1:3848 MCHENRY AVE STE 130
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-1599
Practice Address - Country:US
Practice Address - Phone:209-523-2100
Practice Address - Fax:209-523-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA537901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty