Provider Demographics
NPI:1538559877
Name:PANCHAL, NANDITA RUSHI (DDS)
Entity type:Individual
Prefix:DR
First Name:NANDITA
Middle Name:RUSHI
Last Name:PANCHAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 S MADERA AVE
Mailing Address - Street 2:
Mailing Address - City:KERMAN
Mailing Address - State:CA
Mailing Address - Zip Code:93630-1102
Mailing Address - Country:US
Mailing Address - Phone:909-694-9007
Mailing Address - Fax:
Practice Address - Street 1:184 S MADERA AVE
Practice Address - Street 2:
Practice Address - City:KERMAN
Practice Address - State:CA
Practice Address - Zip Code:93630-1102
Practice Address - Country:US
Practice Address - Phone:559-846-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA642741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice