Provider Demographics
NPI:1285972182
Name:PATTANAYAK DENTAL CORP
Entity type:Organization
Organization Name:PATTANAYAK DENTAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRANATEE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTANAYAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-212-3414
Mailing Address - Street 1:1400 SANTA RITA RD STE C
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-5663
Mailing Address - Country:US
Mailing Address - Phone:925-485-9595
Mailing Address - Fax:925-485-9590
Practice Address - Street 1:1400 SANTA RITA RD
Practice Address - Street 2:#C
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-5666
Practice Address - Country:US
Practice Address - Phone:925-485-9595
Practice Address - Fax:925-485-9590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59207122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty