Provider Demographics
NPI:1417696279
Name:GANDHI, RADHA VARUN (DDS)
Entity Type:Individual
Prefix:
First Name:RADHA
Middle Name:VARUN
Last Name:GANDHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:RADHA
Other - Middle Name:GAURANGKUMAR
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 BADGER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9535
Mailing Address - Country:US
Mailing Address - Phone:408-930-0499
Mailing Address - Fax:
Practice Address - Street 1:1276 HALYARD DR
Practice Address - Street 2:
Practice Address - City:W SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3412
Practice Address - Country:US
Practice Address - Phone:916-454-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA108959122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program