Provider Demographics
NPI:1184251423
Name:BANDARY, DANIEL (DDS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BANDARY
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 1:6280 W 3RD ST APT 423
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-7627
Mailing Address - Country:US
Mailing Address - Phone:818-430-0119
Mailing Address - Fax:
Practice Address - Street 1:6280 W 3RD ST APT 423
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-7627
Practice Address - Country:US
Practice Address - Phone:818-430-0119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADR61068962204E00000X
390200000X
CA1073881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program