Provider Demographics
NPI:1356535330
Name:BAJARS, TANIA (DDS)
Entity type:Individual
Prefix:DR
First Name:TANIA
Middle Name:
Last Name:BAJARS
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 1:4411 32ND ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4502
Mailing Address - Country:US
Mailing Address - Phone:619-865-6119
Mailing Address - Fax:
Practice Address - Street 1:2930 CORONADO AVE STE C
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-2188
Practice Address - Country:US
Practice Address - Phone:619-423-3602
Practice Address - Fax:619-423-8996
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA557221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice