Provider Demographics
NPI:1093324840
Name:GAIDHANE, SIDDHANT (GENERAL DENTIST)
Entity Type:Individual
Prefix:DR
First Name:SIDDHANT
Middle Name:
Last Name:GAIDHANE
Suffix:
Gender:M
Credentials:GENERAL DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 SHOCKOE LN APT 103
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-4084
Mailing Address - Country:US
Mailing Address - Phone:804-269-2710
Mailing Address - Fax:
Practice Address - Street 1:2040 COLISEUM DR STE A27
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3200
Practice Address - Country:US
Practice Address - Phone:757-262-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014170961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice