Healthcare Provider Details

I. General information

NPI: 1649033804
Provider Name (Legal Business Name): RIMMIE K PANDHER DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 MCHENRY VILLAGE WAY STE 1
MODESTO CA
95350-4338
US

IV. Provider business mailing address

1601 MCHENRY VILLAGE WAY STE 1
MODESTO CA
95350-4338
US

V. Phone/Fax

Practice location:
  • Phone: 209-765-6929
  • Fax: 209-577-8584
Mailing address:
  • Phone: 209-765-6929
  • Fax: 209-577-8584

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: DR. RAMINDER KAUR PANDHER
Title or Position: DENTIST
Credential: DMD
Phone: 209-577-1313