Provider Demographics
NPI:1164637484
Name:PANDIT, KUNTAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:KUNTAL
Middle Name:
Last Name:PANDIT
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 1:2128 7TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-3106
Mailing Address - Country:US
Mailing Address - Phone:205-251-6928
Mailing Address - Fax:205-251-6968
Practice Address - Street 1:2128 7TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-3106
Practice Address - Country:US
Practice Address - Phone:205-251-6928
Practice Address - Fax:205-251-6968
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4868122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist