Provider Demographics
NPI:1750772760
Name:PANDENTAL
Entity type:Organization
Organization Name:PANDENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:PEDRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHNIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-275-3399
Mailing Address - Street 1:2206 S CHICKASAW TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-8414
Mailing Address - Country:US
Mailing Address - Phone:407-275-3399
Mailing Address - Fax:
Practice Address - Street 1:2206 S CHICKASAW TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-8414
Practice Address - Country:US
Practice Address - Phone:407-275-3399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14171261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental