Provider Demographics
NPI:1811061344
Name:PATTANAYAK, PRANATEE (DDS)
Entity type:Individual
Prefix:DR
First Name:PRANATEE
Middle Name:
Last Name:PATTANAYAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 SANTA RITA RD STE C
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-5663
Mailing Address - Country:US
Mailing Address - Phone:925-485-9595
Mailing Address - Fax:925-485-9590
Practice Address - Street 1:1400 SANTA RITA RD STE C
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-5663
Practice Address - Country:US
Practice Address - Phone:925-485-9595
Practice Address - Fax:925-485-9590
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120591223G0001X
CA59207122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN966175100Medicaid