Provider Demographics
NPI:1568034247
Name:PANKAJ R GOYAL DDS AZ PC
Entity Type:Organization
Organization Name:PANKAJ R GOYAL DDS AZ PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:GOYAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-594-2057
Mailing Address - Street 1:7170 W CAMINO SAN XAVIER STE A101
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-0834
Mailing Address - Country:US
Mailing Address - Phone:623-594-2057
Mailing Address - Fax:
Practice Address - Street 1:7170 W CAMINO SAN XAVIER STE A101
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-0834
Practice Address - Country:US
Practice Address - Phone:623-594-2057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-13
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty