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General NPI Number Information
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NPI Number | 1215601638
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Entity Type | Individual
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Provider Name | SHIVAKSHI BINA PANCHOLI DDS
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Gender | Female
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Dates
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Enumeration Date | 08/09/2021
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 405 FREDERICK RD STE 152
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City | CATONSVILLE
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State | MD
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Zip | 21228-4645
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Country | US
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Telephone | 410-777-9134
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Fax |
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Provider Business Mailing Address
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Address Line | 116 RANGE RD
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City | GLEN BURNIE
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State | MD
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Zip | 21061-3733
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Country | US
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Telephone | 443-763-0754
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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 | 17573
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License Number State | MD
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