MEDICARE: PANDENTAL

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	261QD0000X	Dental Clinic/Center	DN14171	FL

General Provider Information

NPI Number	:	1750772760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PANDENTAL

Provider Business Mailing Address
First Line	:	2206 S CHICKASAW TRL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-8414
Country	:	US
Telephone Number	:	407-275-3399
Fax Number	:

Provider Business Practice Location Address
First Line	:	2206 S CHICKASAW TRL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-8414
Country	:	US
Telephone Number	:	407-275-3399
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	PEDRAM BEHNIA
Credential	:	DMD
Telephone Number	:	407-275-3399

Provider Enumeration Date	:	02/12/2015
Last Update Date	:	02/12/2015

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Directions to “PANDENTAL ” Practice Location

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