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General NPI Number Information
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NPI Number | 1457167314
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Entity Type | Organization
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Legal Business Name | BANDARY & BAROOTY DDS, A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 15228 HAWTHORNE BLVD STE A
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City | LAWNDALE
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State | CA
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Zip | 90260-2268
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Country | US
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Telephone | 310-220-0456
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Fax |
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Provider Business Mailing Address
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Address Line | 15228 HAWTHORNE BLVD STE A
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City | LAWNDALE
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State | CA
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Zip | 90260-2268
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Country | US
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Telephone | 310-220-0456
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Fax |
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Authorized Official
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Title or Position | DENTIST, CO-OWNER
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Name | DR. DANIEL BANDARY
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Credential | DDS
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Telephone | 818-430-0119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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