Healthcare Provider Details

I. General information

NPI: 1184251423
Provider Name (Legal Business Name): DANIEL BANDARY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6280 W 3RD ST APT 423
LOS ANGELES CA
90036-7627
US

IV. Provider business mailing address

6280 W 3RD ST APT 423
LOS ANGELES CA
90036-7627
US

V. Phone/Fax

Practice location:
  • Phone: 818-430-0119
  • Fax:
Mailing address:
  • Phone: 818-430-0119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number107388
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDR61068962
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: