Healthcare Provider Details

I. General information

NPI: 1861859506
Provider Name (Legal Business Name): RANJIVENDRA NATH DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 E COLORADO BLVD
PASADENA CA
91107-3554
US

IV. Provider business mailing address

1855 E COLORADO BLVD
PASADENA CA
91107-3554
US

V. Phone/Fax

Practice location:
  • Phone: 626-440-0801
  • Fax: 626-440-0803
Mailing address:
  • Phone: 626-440-0801
  • Fax: 626-440-0803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. RANJIVENDRA NATH
Title or Position: PRESIDENT
Credential: DDS
Phone: 626-440-0801