Provider Demographics
NPI:1093069106
Name:WADHWA, PUNEET (DMD)
Entity Type:Individual
Prefix:DR
First Name:PUNEET
Middle Name:
Last Name:WADHWA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12455 VICTORIA GARDENS LN STE 190
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-7534
Mailing Address - Country:US
Mailing Address - Phone:617-610-8918
Mailing Address - Fax:
Practice Address - Street 1:12455 VICTORIA GARDENS LN STE 190
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-7534
Practice Address - Country:US
Practice Address - Phone:617-610-8918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN95801223G0001X
CA620141223P0221X
AZ94301223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice