Provider Demographics
NPI:1265989289
Name:GAGANDEEP PANDHER DDS DENTAL CORPORATION
Entity type:Organization
Organization Name:GAGANDEEP PANDHER DDS DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAGANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:PANDHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-600-0065
Mailing Address - Street 1:5460 SUNOL BLVD
Mailing Address - Street 2:STE-5
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7752
Mailing Address - Country:US
Mailing Address - Phone:925-600-0065
Mailing Address - Fax:925-600-1005
Practice Address - Street 1:5460 SUNOL BLVD
Practice Address - Street 2:STE # 5
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566
Practice Address - Country:US
Practice Address - Phone:925-600-0065
Practice Address - Fax:925-600-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62589122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty