Puneet Wadhwa, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

62014 Issued in CA

Practice address

12455 Victoria Gardens LN Ste 190
Rancho Cucamonga, CA 91739-7534

Phone

(617) 610-8918

NPI assigned

Oct 29, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462147200000",
    "number": "1093069106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12455 VICTORIA GARDENS LN STE 190",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917397534",
            "telephone_number": "617-610-8918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12455 VICTORIA GARDENS LN STE 190",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917397534",
            "telephone_number": "617-610-8918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADHWA",
        "first_name": "PUNEET",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-29",
        "last_updated": "2016-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "9580",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "62014",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AZ",
            "license": "9430",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mindy Vu, DMD
• Thy Vu
• Aneri Vyas
• Hailey Sierra Wada, RN, IBCLC
• Kathleen Wade
• Wal-Mart Stores, Inc. (Vision Center 30-1922)
• Lauren Noelle Walcker
• Tyrone Jermaine Walcott, NP
• Lauren Waldron
• Anisa Marie Wales

• Pediatric Dentistry in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.