Provider Demographics
NPI:1386197630
Name:PANDE, GAURI (DDS)
Entity Type:Individual
Prefix:DR
First Name:GAURI
Middle Name:
Last Name:PANDE
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 1:25401 EASTERN MARKETPLACE PLZ
Mailing Address - Street 2:SUITE 165
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-5782
Mailing Address - Country:US
Mailing Address - Phone:217-540-5100
Mailing Address - Fax:
Practice Address - Street 1:25401 EASTERN MARKETPLACE PLZ
Practice Address - Street 2:SUITE 165
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-5782
Practice Address - Country:US
Practice Address - Phone:217-540-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415323122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist