MEDICARE: DEEPA PANDIAN D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	55231	CA
2	1223P0221X	Pediatric Dentistry	0401417575	VA

General Provider Information

NPI Number	:	1326237116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEEPA PANDIAN D.M.D.

Provider Business Mailing Address
First Line	:	5205 MELROSE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-3144
Country	:	US
Telephone Number	:	323-337-1789
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 COLUMBIA PIKE STE A
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-5867
Country	:	US
Telephone Number	:	703-671-5437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	02/14/2024

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