Provider Demographics
NPI:1144688532
Name:GAIDUCHIK, ANDREY (DDS)
Entity type:Individual
Prefix:
First Name:ANDREY
Middle Name:
Last Name:GAIDUCHIK
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 1:1350 W ROBINHOOD DR STE 20
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5519
Mailing Address - Country:US
Mailing Address - Phone:209-477-6700
Mailing Address - Fax:
Practice Address - Street 1:5740 WINDMILL WAY STE 16
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-1379
Practice Address - Country:US
Practice Address - Phone:916-331-0841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1032001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty