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General NPI Number Information
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NPI Number | 1639561145
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Entity Type | Individual
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Provider Name | ADITYA NIKHIL PANDYA DMD, MPH
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Gender | Male
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Dates
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Enumeration Date | 02/21/2015
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 6120 W BELL RD SUITE #190
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City | GLENDALE
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State | AZ
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Zip | 85308-3781
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Country | US
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Telephone | 602-978-0338
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Fax |
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Provider Business Mailing Address
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Address Line | 2668 S STUART AVE
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City | GILBERT
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State | AZ
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Zip | 85295-2375
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Country | US
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Telephone | 651-269-6978
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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 | 9424
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License Number State | AZ
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