Provider Demographics
NPI:1073714861
Name:GIDWANI, NAGESH H (DDS)
Entity Type:Individual
Prefix:DR
First Name:NAGESH
Middle Name:H
Last Name:GIDWANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18631 N 19TH AVE
Mailing Address - Street 2:STE 108
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027
Mailing Address - Country:US
Mailing Address - Phone:623-582-8088
Mailing Address - Fax:623-582-5346
Practice Address - Street 1:18631 N 19TH AVE
Practice Address - Street 2:STE 108
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027
Practice Address - Country:US
Practice Address - Phone:623-582-8088
Practice Address - Fax:623-582-5346
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZA3151122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist