Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 28657 | TX |
N | 1223P0106X | Oral and Maxillofacial Pathology | 28657 | TX |
NPI | 1922348051 |
---|---|
Provider Name | Dr. Pavithra Soundarapandian |
First Address | Bedford, TX 76021-5702 |
Second Address | Bedford, TX 76021-5702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2013 |
Last Update Date | 03/05/2018 |