Provider Demographics
NPI:1851498547
Name:DALVIR PANNU DDS INC
Entity Type:Organization
Organization Name:DALVIR PANNU DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAVNEET
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:PANNU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-608-4166
Mailing Address - Street 1:40880 FREMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-4334
Mailing Address - Country:US
Mailing Address - Phone:510-792-9292
Mailing Address - Fax:510-792-9296
Practice Address - Street 1:40880 FREMONT BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-4334
Practice Address - Country:US
Practice Address - Phone:510-792-9292
Practice Address - Fax:510-792-9296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty