Provider Demographics
NPI:1417086125
Name:PANJALI, AEKLAVYA (DDS DDS)
Entity Type:Individual
Prefix:MR
First Name:AEKLAVYA
Middle Name:
Last Name:PANJALI
Suffix:
Gender:M
Credentials:DDS DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601
Mailing Address - Country:US
Mailing Address - Phone:315-779-8080
Mailing Address - Fax:315-779-8085
Practice Address - Street 1:140 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-779-8080
Practice Address - Fax:315-779-8085
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000016122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist