Provider Demographics
NPI:1003044082
Name:GARCIA, GANDY S (DDS)
Entity Type:Individual
Prefix:
First Name:GANDY
Middle Name:S
Last Name:GARCIA
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 1:1216 N 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-3017
Mailing Address - Country:US
Mailing Address - Phone:773-732-3477
Mailing Address - Fax:
Practice Address - Street 1:3915 W 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3704
Practice Address - Country:US
Practice Address - Phone:773-522-2929
Practice Address - Fax:773-522-2930
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028036122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist