Provider Demographics
NPI:1215263330
Name:DESAI-PANDYA, PAULOMI (DDS)
Entity type:Individual
Prefix:DR
First Name:PAULOMI
Middle Name:
Last Name:DESAI-PANDYA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:PAULOMI
Other - Middle Name:RAJENDRA
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11055 LITTLE PATUXENT PKWY STE 207
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2898
Mailing Address - Country:US
Mailing Address - Phone:410-997-0555
Mailing Address - Fax:
Practice Address - Street 1:11055 LITTLE PATUXENT PKWY STE 207
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2898
Practice Address - Country:US
Practice Address - Phone:410-997-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD123561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice