1669067302 NPI number — R & N PANCHAL DENTAL GROUP, A PROFESSIONAL DENTAL CORPORATION

Table of content: AMANDA LEIGH PEATS PMHNP (NPI 1336716372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669067302 NPI number — R & N PANCHAL DENTAL GROUP, A PROFESSIONAL DENTAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R & N PANCHAL DENTAL GROUP, A PROFESSIONAL DENTAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669067302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
184 S MADERA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KERMAN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93630-1102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-846-3333
Provider Business Mailing Address Fax Number:
559-846-8999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
184 S MADERA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KERMAN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93630-1102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-846-3333
Provider Business Practice Location Address Fax Number:
559-846-8999
Provider Enumeration Date:
03/04/2021

Additional Information

Authorized Official

Authorized Official Last Name:
PANCHAL
Authorized Official First Name:
NANDITA
Authorized Official Middle Name:
RUSHI
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
559-846-3333

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 64274 . This is a "DENTAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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