Provider Demographics
NPI:1083820096
Name:TIEMPETPAISAL, PANADDA (DDS)
Entity Type:Individual
Prefix:
First Name:PANADDA
Middle Name:
Last Name:TIEMPETPAISAL
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 1:199 OLDENBURG LANE
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860
Mailing Address - Country:US
Mailing Address - Phone:951-734-4550
Mailing Address - Fax:
Practice Address - Street 1:1080 E WASHINGTON ST
Practice Address - Street 2:STE B
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324
Practice Address - Country:US
Practice Address - Phone:909-738-9099
Practice Address - Fax:909-824-1677
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47328122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist