Provider Demographics
NPI:1922448067
Name:PANDEY, RUPESH (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUPESH
Middle Name:
Last Name:PANDEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 PORTLAND COBALT RD STE 1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-1981
Mailing Address - Country:US
Mailing Address - Phone:860-342-4141
Mailing Address - Fax:
Practice Address - Street 1:553 PORTLAND COBALT RD STE 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-1981
Practice Address - Country:US
Practice Address - Phone:860-342-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT109891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice