Healthcare Provider Details

I. General information

NPI: 1811765324
Provider Name (Legal Business Name): NEHA BANDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20650 W ROOSEVELT ST
BUCKEYE AZ
85326-1556
US

IV. Provider business mailing address

20650 W ROOSEVELT ST
BUCKEYE AZ
85326-1556
US

V. Phone/Fax

Practice location:
  • Phone: 480-347-0780
  • Fax: 480-305-0156
Mailing address:
  • Phone: 480-347-0780
  • Fax: 480-305-0156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD012907
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: