Provider Demographics
NPI:1164749891
Name:PANCHAL, NIRMALA UMEDRAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:NIRMALA
Middle Name:UMEDRAM
Last Name:PANCHAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:NIRMALA
Other - Middle Name:U
Other - Last Name:PANCHAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1270 DILL CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-7774
Mailing Address - Country:US
Mailing Address - Phone:951-756-5570
Mailing Address - Fax:951-340-0876
Practice Address - Street 1:1270 DILL CIR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-7774
Practice Address - Country:US
Practice Address - Phone:951-756-5570
Practice Address - Fax:951-340-0876
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA401051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice