Healthcare Provider Details

I. General information

NPI: 1194134692
Provider Name (Legal Business Name): PAWAR DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1568 CREEKSIDE DR STE 202
FOLSOM CA
95630-3449
US

IV. Provider business mailing address

217 OXLEIGH WAY
FOLSOM CA
95630-8412
US

V. Phone/Fax

Practice location:
  • Phone: 916-220-1751
  • Fax:
Mailing address:
  • Phone: 916-235-6212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. AMAR PAWAR
Title or Position: OWNER
Credential: D.D.S.
Phone: 916-232-6212