Basic Information
| Provider Information | |||||||||
| NPI: | 1225554025 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DALAL | ||||||||
| FirstName: | HEMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 88 HILLSIDE BLVD APT 228 | ||||||||
| Address2: | |||||||||
| City: | DALY CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940146807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3025441694 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2825 EL CAMINO REAL | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950512901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083434170 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2017 | ||||||||
| LastUpdateDate: | 08/14/2017 | ||||||||
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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 | 101754 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.