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General NPI Number Information
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NPI Number | 1073885794
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Entity Type | Individual
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Provider Name | PUJA MISTRY D.M.D
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Gender | Female
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Dates
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Enumeration Date | 01/27/2012
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Last Update Date | 07/26/2013
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Provider Practice Location Address
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Address Line | 16111 PLUMMER ST
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City | NORTH HILLS
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State | CA
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Zip | 91343-2036
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Country | US
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Telephone | 818-891-7711
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Fax |
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Provider Business Mailing Address
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Address Line | 3221 OVERLAND AVE APT 2224
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City | LOS ANGELES
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State | CA
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Zip | 90034-4502
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Country | US
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Telephone | 951-515-9109
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 62375
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License Number State | CA
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