Provider Demographics
NPI:1457167314
Name:BANDARY & BAROOTY DDS, A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:BANDARY & BAROOTY DDS, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BANDARY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-430-0119
Mailing Address - Street 1:15228 HAWTHORNE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-2268
Mailing Address - Country:US
Mailing Address - Phone:310-220-0456
Mailing Address - Fax:
Practice Address - Street 1:15228 HAWTHORNE BLVD STE A
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2268
Practice Address - Country:US
Practice Address - Phone:310-220-0456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BANDARY & BAROOTY DDS, A PROFESSIONAL DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty