Basic Information
| Provider Information | |||||||||
| NPI: | 1215284195 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOSAVI | ||||||||
| FirstName: | TANUJA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2455 TAMALPAIS ST | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN VIEW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940434129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133757309 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5130 STEVENS CREEK BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951291019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4085579830 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2012 | ||||||||
| LastUpdateDate: | 12/07/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 64665 | CA | Y | Dental Providers | Dentist | General Practice | 1223G0001X | 10830 | CT | N | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 008042082 | 05 | CT | MEDICAID |