Provider Demographics
NPI:1881973352
Name:VANDANA, UNKNOWN (DDS)
Entity type:Individual
Prefix:
First Name:UNKNOWN
Middle Name:
Last Name:VANDANA
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 1:7342 ROYAL PORTRUSH DR
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-5252
Mailing Address - Country:US
Mailing Address - Phone:704-280-9276
Mailing Address - Fax:
Practice Address - Street 1:34302 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-3334
Practice Address - Country:US
Practice Address - Phone:440-946-4241
Practice Address - Fax:440-550-4519
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH235281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice