Provider Demographics
NPI:1073223194
Name:NANDA SPECIALISTS: A DENTAL GROUP
Entity Type:Organization
Organization Name:NANDA SPECIALISTS: A DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MCCLORY
Authorized Official - Last Name:NANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-821-1992
Mailing Address - Street 1:2111 KINGSBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-3730
Mailing Address - Country:US
Mailing Address - Phone:907-821-1992
Mailing Address - Fax:
Practice Address - Street 1:3088 TELEGRAPH RD STE A
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3235
Practice Address - Country:US
Practice Address - Phone:907-821-1992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty