Basic Information
Provider Information
NPI: 1932685716
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAWALHA
FirstName: NINA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 22636 SILVER OAK WAY
Address2:  
City: CUPERTINO
State: CA
PostalCode: 950145622
CountryCode: US
TelephoneNumber: 8483911287
FaxNumber:  
Practice Location
Address1: 2670 S WHITE RD STE 200
Address2:  
City: SAN JOSE
State: CA
PostalCode: 951482073
CountryCode: US
TelephoneNumber: 4087299700
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/16/2018
LastUpdateDate: 07/16/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X102795CAY Dental ProvidersDentist 

No ID Information.


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