Provider Demographics
NPI:1669067302
Name:R & N PANCHAL DENTAL GROUP, A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:R & N PANCHAL DENTAL GROUP, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANDITA
Authorized Official - Middle Name:RUSHI
Authorized Official - Last Name:PANCHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-846-3333
Mailing Address - Street 1:184 S MADERA AVE
Mailing Address - Street 2:
Mailing Address - City:KERMAN
Mailing Address - State:CA
Mailing Address - Zip Code:93630-1102
Mailing Address - Country:US
Mailing Address - Phone:559-846-3333
Mailing Address - Fax:559-846-8999
Practice Address - Street 1:184 S MADERA AVE
Practice Address - Street 2:
Practice Address - City:KERMAN
Practice Address - State:CA
Practice Address - Zip Code:93630-1102
Practice Address - Country:US
Practice Address - Phone:559-846-3333
Practice Address - Fax:559-846-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA64274OtherDENTAL LICENSE