Healthcare Provider Details

I. General information

NPI: 1821542366
Provider Name (Legal Business Name): PAVNEET BAINS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2016
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 WESTWOOD DR
SAN JOSE CA
95125-5105
US

IV. Provider business mailing address

190 RYLAND ST APT 3227
SAN JOSE CA
95110-3905
US

V. Phone/Fax

Practice location:
  • Phone: 408-266-0388
  • Fax:
Mailing address:
  • Phone: 916-799-2794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number108792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: