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1081 Market Pl Ste 100 San Ramon CA 94583-4749 | |
| (408) 490-0182 | |
| (408) 624-4545 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1081 Market Pl, San Ramon, California |
| Authorized Official Name and Position | Srujal Harshad Shah (PRESIDENT) |
| Authorized Official Contact | 4084900182 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
6120 Hellyer Ave Ste 125 San Jose CA 95138-1066 Ph: (408) 490-0182 | 1081 Market Pl Ste 100 San Ramon CA 94583-4749 Ph: (408) 490-0182 |
| NPI Number | 1801286505 |
|---|---|
| Provider Enumeration Date | 02/02/2015 |
| Last Update Date | 10/16/2023 |
| Medicare PECOS PAC ID | 4486840634 |
|---|---|
| Medicare Enrollment ID | O20170504000050 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801286505 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 58754 (California) | Primary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Secondary |
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