MEDICARE: DR. RANJIVENDRA NATH DDS

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	1223X2210X	Orofacial Pain Dentistry	46304	CA
2	1223G0001X	General Practice Dentistry	46304	CA

General Provider Information

NPI Number	:	1669477931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANJIVENDRA NATH DDS

Provider Business Mailing Address
First Line	:	1855 E COLORADO BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3554
Country	:	US
Telephone Number	:	626-404-0801
Fax Number	:	626-603-2762

Provider Business Practice Location Address
First Line	:	1855 E COLORADO BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3554
Country	:	US
Telephone Number	:	626-404-0801
Fax Number	:	626-603-2762

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	09/10/2020

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