Provider Demographics
NPI:1508856980
Name:PANDYA, AMISH DUSHYANT (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMISH
Middle Name:DUSHYANT
Last Name:PANDYA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9335 CALUMET AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-4175
Mailing Address - Country:US
Mailing Address - Phone:219-836-2092
Mailing Address - Fax:219-836-9501
Practice Address - Street 1:9335 CALUMET AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4175
Practice Address - Country:US
Practice Address - Phone:219-836-2092
Practice Address - Fax:219-836-9501
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011539A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201048300Medicaid