Meridian Dental Associates
Dentist, General Practice in San Jose, CA. Organization (NPI-2).
NPI number1982131306
StatusActive
Last updated in NPPESMay 9, 2024
Details
- NPI
- 1982131306
- Entity type
- Organization (NPI-2)
- Legal business name
- Meridian Dental Associates
- Organization subpart
- No
- Enumeration date
- May 16, 2017
- Certification date
- Feb 2, 2021
- Last updated
- May 9, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
| 122300000X | Dentist | – | – | |
| 1223E0200X | Dentist, Endodontics | – | – | |
| 1223P0300X | Dentist, Periodontics | – | – | |
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | – | – | |
| 1223X0400X | Dentist, Orthodontics and Dentofacial Orthopedics | – | – | |
| 124Q00000X | Dental Hygienist | – | – | |
| 126800000X | Dental Assistant | – | – |
Other names
- Willow Glen Dental Center (Doing Business As)
Practice location
1241 Meridian AvenueSan Jose, CA 95125
Phone 408-266-6144 · Fax 408-676-4443
Mailing address
1241 Meridian AvenueSan Jose, CA 95125
Phone 408-266-6144 · Fax 408-676-4443
Authorized official
Raoul R Shah
Owner
4082666144
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