Provider Demographics
NPI:1427391804
Name:GANDHI, SHIVEN (DMD)
Entity Type:Individual
Prefix:
First Name:SHIVEN
Middle Name:
Last Name:GANDHI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2176 OAK RD
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2374
Mailing Address - Country:US
Mailing Address - Phone:770-985-9559
Mailing Address - Fax:
Practice Address - Street 1:2176 OAK RD
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2374
Practice Address - Country:US
Practice Address - Phone:770-985-9559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014725122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist