Provider Demographics
NPI:1730446972
Name:RUPAREL, PANNA B (DDS)
Entity type:Individual
Prefix:DR
First Name:PANNA
Middle Name:B
Last Name:RUPAREL
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 1:9 RED COAT PL
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-0720
Mailing Address - Country:US
Mailing Address - Phone:714-391-2031
Mailing Address - Fax:
Practice Address - Street 1:6543 TOPANGA CANYON BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91303-2622
Practice Address - Country:US
Practice Address - Phone:714-391-2031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA496551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice