Provider Demographics
NPI:1447983143
Name:PANDHI, SHRUTI (AEGD)
Entity type:Individual
Prefix:
First Name:SHRUTI
Middle Name:
Last Name:PANDHI
Suffix:
Gender:F
Credentials:AEGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5456 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-4559
Mailing Address - Country:US
Mailing Address - Phone:352-605-8866
Mailing Address - Fax:
Practice Address - Street 1:5456 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4559
Practice Address - Country:US
Practice Address - Phone:352-605-8866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL272901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty