Provider Demographics
NPI:1265671176
Name:PANDYA PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:PANDYA PROFESSIONAL DENTAL CORPORATION
Other - Org Name:BAY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:PANDYA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-542-4333
Mailing Address - Street 1:16910 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-3215
Mailing Address - Country:US
Mailing Address - Phone:310-542-4333
Mailing Address - Fax:310-370-6779
Practice Address - Street 1:16910 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-3215
Practice Address - Country:US
Practice Address - Phone:310-542-4333
Practice Address - Fax:310-370-6779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50805122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty