Healthcare Provider Details

I. General information

NPI: 1730440462
Provider Name (Legal Business Name): PUNEET SANDHU PANDE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 S. MAIN ST.
MILPITAS CA
95035
US

IV. Provider business mailing address

414 S. MAIN ST.
MILPITAS CA
95035
US

V. Phone/Fax

Practice location:
  • Phone: 408-934-0693
  • Fax: 408-934-1055
Mailing address:
  • Phone: 408-934-0693
  • Fax: 408-934-1055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number53104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: