Provider Demographics
NPI:1437446580
Name:GERSHKOVICH, CANDACE FAITH (DMD)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:FAITH
Last Name:GERSHKOVICH
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 1:11402 N CAVE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020
Mailing Address - Country:US
Mailing Address - Phone:480-577-1958
Mailing Address - Fax:215-914-2177
Practice Address - Street 1:4235 W. THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053
Practice Address - Country:US
Practice Address - Phone:215-914-2157
Practice Address - Fax:215-914-2177
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0387581223G0001X
AZD0087041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice