Provider Demographics
NPI:1043695299
Name:VADI, THANMAYA (DDS)
Entity type:Individual
Prefix:DR
First Name:THANMAYA
Middle Name:
Last Name:VADI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27661 BOUQUET CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-1793
Mailing Address - Country:US
Mailing Address - Phone:949-690-2132
Mailing Address - Fax:
Practice Address - Street 1:27661 BOUQUET CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-1793
Practice Address - Country:US
Practice Address - Phone:661-347-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE605848401223G0001X
CADDS1082521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice