Provider Demographics
NPI:1427187103
Name:PALANIANDAVAN, PARTHIBAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:PARTHIBAN
Middle Name:
Last Name:PALANIANDAVAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 BENJAMIN FRANKLIN PKWY APT W409
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3626
Mailing Address - Country:US
Mailing Address - Phone:215-222-1154
Mailing Address - Fax:
Practice Address - Street 1:3200 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-3217
Practice Address - Country:US
Practice Address - Phone:215-569-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036619122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist