Provider Demographics
NPI:1053525980
Name:PATHMANABHAN, PATHMINI (DDS)
Entity type:Individual
Prefix:DR
First Name:PATHMINI
Middle Name:
Last Name:PATHMANABHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 MOWRY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1510
Mailing Address - Country:US
Mailing Address - Phone:510-796-7600
Mailing Address - Fax:510-796-7602
Practice Address - Street 1:3200 MOWRY AVE STE B
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1510
Practice Address - Country:US
Practice Address - Phone:510-796-7600
Practice Address - Fax:510-796-7602
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2018-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA438401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice