Provider Demographics
NPI:1356838528
Name:NANDITA PANCHAL DDS, A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:NANDITA PANCHAL DDS, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:GLO DENTAL, DENTAL GROUP OF DRS PANCHAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANDITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANCHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-762-7587
Mailing Address - Street 1:933 WHITLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CORCORAN
Mailing Address - State:CA
Mailing Address - Zip Code:93212-2429
Mailing Address - Country:US
Mailing Address - Phone:559-762-7587
Mailing Address - Fax:559-762-7118
Practice Address - Street 1:933 WHITLEY AVE
Practice Address - Street 2:
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-2429
Practice Address - Country:US
Practice Address - Phone:559-762-7587
Practice Address - Fax:559-762-7118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64274261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental