MEDICARE: DR. DEEPALI MOHINDRA PEDNEKAR D.D.S

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	122300000X	Dentist	019.030427	IL
2	122300000X	Dentist	108733	CA

General Provider Information

NPI Number	:	1790151892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEEPALI MOHINDRA PEDNEKAR D.D.S

Provider Business Mailing Address
First Line	:	23304 SANDALWOOD ST
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91307-1423
Country	:	US
Telephone Number	:	818-667-8435
Fax Number	:

Provider Business Practice Location Address
First Line	:	30200 AGOURA RD STE 270
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-5440
Country	:	US
Telephone Number	:	818-667-8435
Fax Number	:

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

Provider Enumeration Date	:	08/12/2015
Last Update Date	:	01/15/2026

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