Provider Demographics
NPI:1598882813
Name:WADHWA, PERMINDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:PERMINDER
Middle Name:
Last Name:WADHWA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-2643
Mailing Address - Country:US
Mailing Address - Phone:954-467-4842
Mailing Address - Fax:954-762-3644
Practice Address - Street 1:780 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-2643
Practice Address - Country:US
Practice Address - Phone:954-467-4842
Practice Address - Fax:954-762-3644
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN080761223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health