1386959013 NPI number — DR. PAWANDEEP BAJWA D.M.D.

Table of content: MR. TED P BUKKY (NPI 1396442562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386959013 NPI number — DR. PAWANDEEP BAJWA D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAJWA
Provider First Name:
PAWANDEEP
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAJWA
Provider Other First Name:
PAWANDEEP
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.M.D
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1386959013
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10664 E POINT TWENTY TWO BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85212-8874
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-673-0223
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10664 E POINT TWENTY TWO BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85212-8874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-360-3073
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DE60172610 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: D008505 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)