Provider Demographics
NPI:1477725539
Name:MANISHKUMAR R GANDHI DDS PC
Entity Type:Organization
Organization Name:MANISHKUMAR R GANDHI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANISHKUMAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:GANDHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-376-8444
Mailing Address - Street 1:716 MIDWEST CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2531
Mailing Address - Country:US
Mailing Address - Phone:773-376-8444
Mailing Address - Fax:
Practice Address - Street 1:1952 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-4204
Practice Address - Country:US
Practice Address - Phone:773-376-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-29
Last Update Date:2008-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19015777261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental