Healthcare Provider Details

I. General information

NPI: 1669067302
Provider Name (Legal Business Name): R & N PANCHAL DENTAL GROUP, A PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 S MADERA AVE
KERMAN CA
93630-1102
US

IV. Provider business mailing address

184 S MADERA AVE
KERMAN CA
93630-1102
US

V. Phone/Fax

Practice location:
  • Phone: 559-846-3333
  • Fax: 559-846-8999
Mailing address:
  • Phone: 559-846-3333
  • Fax: 559-846-8999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NANDITA RUSHI PANCHAL
Title or Position: OWNER
Credential: DDS
Phone: 559-846-3333