Provider Demographics
NPI:1629074729
Name:PANDIT, DEVNA UMAKANT (DDS)
Entity Type:Individual
Prefix:
First Name:DEVNA
Middle Name:UMAKANT
Last Name:PANDIT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3191 HUTTON PL
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-6689
Mailing Address - Country:US
Mailing Address - Phone:860-992-7031
Mailing Address - Fax:
Practice Address - Street 1:2990 W GRANT LINE RD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95304-7901
Practice Address - Country:US
Practice Address - Phone:209-830-7797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57585122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002093475Medicaid