Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 9580 | TN |
N | 213EG0000X | General Practice | 9580 | TN |
Y | 1223P0221X | Pediatric Dentist | 62014 | CA |
N | 1223P0221X | Pediatric Dentist | 9430 | AZ |
NPI | 1093069106 |
---|---|
Provider Name | Dr. Puneet Wadhwa |
First Address | Rancho Cucamonga, CA 91739-7534 |
Second Address | Rancho Cucamonga, CA 91739-7534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2012 |
Last Update Date | 02/05/2016 |