Provider Demographics
NPI:1639561145
Name:PANDYA, ADITYA NIKHIL (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ADITYA
Middle Name:NIKHIL
Last Name:PANDYA
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2668 S STUART AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-2375
Mailing Address - Country:US
Mailing Address - Phone:651-269-6978
Mailing Address - Fax:
Practice Address - Street 1:6120 W BELL RD
Practice Address - Street 2:SUITE #190
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3781
Practice Address - Country:US
Practice Address - Phone:602-978-0338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-21
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9424122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist