Healthcare Provider Details

I. General information

NPI: 1376169714
Provider Name (Legal Business Name): PUNEET KAUR PANDHER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 09/24/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 EAST WASHINGTON AVE
EARLIMART CA
93219-9321
US

IV. Provider business mailing address

476 EAST WASHINGTON AVE
EARLIMART CA
93219-9460
US

V. Phone/Fax

Practice location:
  • Phone: 213-249-8339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00204486
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberT-DEN.00000049
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number105654
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: