Provider Demographics
NPI:1366980492
Name:PHALTANKAR, POORNA (DMD)
Entity type:Individual
Prefix:DR
First Name:POORNA
Middle Name:
Last Name:PHALTANKAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 W ABINGDON DR APT 201
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1083
Mailing Address - Country:US
Mailing Address - Phone:757-277-2181
Mailing Address - Fax:
Practice Address - Street 1:2391 BRANDERMILL BLVD
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1984
Practice Address - Country:US
Practice Address - Phone:410-451-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice