MEDICARE: RANJIVENDRA NATH DDS INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1223E0200X	Endodontics
2	1223G0001X	General Practice Dentistry
3	1223P0300X	Periodontics
4	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
5	122300000X	Dentist

General Provider Information

NPI Number	:	1861859506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANJIVENDRA NATH DDS INC

Provider Business Mailing Address
First Line	:	1855 E COLORADO BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3554
Country	:	US
Telephone Number	:	626-440-0801
Fax Number	:	626-440-0803

Provider Business Practice Location Address
First Line	:	1855 E COLORADO BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3554
Country	:	US
Telephone Number	:	626-440-0801
Fax Number	:	626-440-0803

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RANJIVENDRA NATH
Credential	:	DDS
Telephone Number	:	626-440-0801

Provider Enumeration Date	:	01/26/2016
Last Update Date	:	01/26/2016

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