Provider Demographics
NPI:1760587729
Name:PANDIT, SHIVANI K (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHIVANI
Middle Name:K
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 1:28425 STATE HIGHWAY 75
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:AL
Mailing Address - Zip Code:35121-1657
Mailing Address - Country:US
Mailing Address - Phone:205-625-4384
Mailing Address - Fax:205-625-4737
Practice Address - Street 1:28425 STATE HIGHWAY 75
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-1657
Practice Address - Country:US
Practice Address - Phone:205-625-4384
Practice Address - Fax:205-625-4737
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL45371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51077758OtherBLUE CROSS PROVIDER #
AL577227OtherUNITED CORCORDIA PROVIDER
AL353978OtherCOMPBENEFITS FACILITY #
AL529916600Medicaid
AL009927915Medicaid
AL4537OtherSTATE LICENCE #