Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 47954 | CA |
N | 1223D0001X | Dental Public Health | 47954 | CA |
NPI | 1073795621 |
---|---|
Provider Name | Dr. Jayasree Mettu |
First Address | Danville, CA 94506-1225 |
Second Address | Danville, CA 94506-1225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2007 |
Last Update Date | 07/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BM7234090 | DEA# (01) | CA |