Provider Demographics
NPI:1124207246
Name:GANDHI, SHWETA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHWETA
Middle Name:
Last Name:GANDHI
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 1:338 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:PROSPECT PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19076-2421
Mailing Address - Country:US
Mailing Address - Phone:610-532-5000
Mailing Address - Fax:610-461-1119
Practice Address - Street 1:338 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:PROSPECT PARK
Practice Address - State:PA
Practice Address - Zip Code:19076-2421
Practice Address - Country:US
Practice Address - Phone:610-532-5000
Practice Address - Fax:610-461-1119
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023621001223G0001X
PADS0372931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice