Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 062233 | NY |
NPI | 1073274908 |
---|---|
Provider Name | Dr. Vidhi Mukul Pandya |
First Address | Bloomington, IL 61704-1426 |
Second Address | Watertown, NY 13601-4353 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2022 |
Last Update Date | 03/01/2022 |