Healthcare Provider Details

I. General information

NPI: 1962412130
Provider Name (Legal Business Name): DARSHAN J PANCHAL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SUNRISE HWY SUITE 106
LINDENHURST NY
11757-2598
US

IV. Provider business mailing address

150 SUNRISE HWY SUITE 106
LINDENHURST NY
11757-2598
US

V. Phone/Fax

Practice location:
  • Phone: 631-226-2525
  • Fax: 631-226-7715
Mailing address:
  • Phone: 631-226-2525
  • Fax: 631-226-7715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number045648
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: