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General NPI Number Information
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NPI Number | 1356838528
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Entity Type | Organization
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Legal Business Name | NANDITA PANCHAL DDS, A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 04/13/2018
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Last Update Date | 04/13/2018
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Provider Practice Location Address
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Address Line | 933 WHITLEY AVE
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City | CORCORAN
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State | CA
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Zip | 93212-2429
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Country | US
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Telephone | 559-762-7587
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Fax | 559-762-7118
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Provider Business Mailing Address
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Address Line | 933 WHITLEY AVE
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City | CORCORAN
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State | CA
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Zip | 93212-2429
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Country | US
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Telephone | 559-762-7587
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Fax | 559-762-7118
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Authorized Official
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Title or Position | PRESIDENT
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Name | NANDITA PANCHAL
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Credential | DDS
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Telephone | 559-762-7587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 64274
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License Number State | CA
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