Healthcare Provider Details

I. General information

NPI: 1760906861
Provider Name (Legal Business Name): MEGHANA PANCHOLI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 EASTRIDGE LOOP STE 1060
SAN JOSE CA
95122-1478
US

IV. Provider business mailing address

33255 9TH ST
UNION CITY CA
94587-2137
US

V. Phone/Fax

Practice location:
  • Phone: 408-238-6684
  • Fax:
Mailing address:
  • Phone: 510-471-5880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number101584
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: