Provider Demographics
NPI:1164965299
Name:PANJRATH HANS DHARMA DENTAL A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PANJRATH HANS DHARMA DENTAL A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-923-5297
Mailing Address - Street 1:2180 STORY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1608
Mailing Address - Country:US
Mailing Address - Phone:408-923-5297
Mailing Address - Fax:
Practice Address - Street 1:2180 STORY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1608
Practice Address - Country:US
Practice Address - Phone:408-923-5297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59700122300000X
CA60818122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1992090856OtherDENTICAL
CA1326354994OtherDENTICAL