Healthcare Provider Details

I. General information

NPI: 1326073958
Provider Name (Legal Business Name): SUNEN G PANDYA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8014 N LOWER SACRAMENTO RD STE B&C
STOCKTON CA
95210-3753
US

IV. Provider business mailing address

8014 N LOWER SACRAMENTO RD, SUITE # B & C,
STOCKTON CA
95210-3747
US

V. Phone/Fax

Practice location:
  • Phone: 209-451-1133
  • Fax: 209-433-4300
Mailing address:
  • Phone: 209-451-1133
  • Fax: 209-433-4300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number50805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: