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General NPI Number Information
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NPI Number | 1073223194
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Entity Type | Organization
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Legal Business Name | NANDA SPECIALISTS: A DENTAL GROUP
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Dates
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Enumeration Date | 11/30/2022
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 3088 TELEGRAPH RD STE A
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City | VENTURA
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State | CA
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Zip | 93003-3235
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Country | US
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Telephone | 907-821-1992
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Fax |
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Provider Business Mailing Address
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Address Line | 2111 KINGSBRIDGE WAY
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City | OXNARD
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State | CA
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Zip | 93035-3730
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Country | US
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Telephone | 907-821-1992
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PATRICIA MCCLORY NANDA
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Credential | DMD
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Telephone | 907-821-1992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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