Provider Demographics
NPI:1902257595
Name:PANDYA, PRIYANKA (DMD)
Entity type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:
Last Name:PANDYA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 BAYOU PATH DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3496
Mailing Address - Country:US
Mailing Address - Phone:630-207-2758
Mailing Address - Fax:
Practice Address - Street 1:407 W OGDEN AVE
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-2299
Practice Address - Country:US
Practice Address - Phone:630-241-3737
Practice Address - Fax:630-241-6894
Is Sole Proprietor?:No
Enumeration Date:2016-06-25
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190307681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice