Provider Demographics
NPI:1811417298
Name:PANDES, BETHANY NOELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:NOELLE
Last Name:PANDES
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 1:3464 N SALIDA ST STE A
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011
Mailing Address - Country:US
Mailing Address - Phone:303-307-9999
Mailing Address - Fax:303-307-9992
Practice Address - Street 1:3464 N SALIDA ST STE A
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011
Practice Address - Country:US
Practice Address - Phone:303-307-9999
Practice Address - Fax:303-307-9992
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN00203279122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14037062OtherCAQH
CO1811417298Medicaid