Provider Demographics
NPI:1528398856
Name:GANDOLFI, CLARA (RDH, BSDH)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:GANDOLFI
Suffix:
Gender:F
Credentials:RDH, BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LANDSTUHL DENTAC
Mailing Address - Street 2:CMR 402
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180
Mailing Address - Country:US
Mailing Address - Phone:4963719-464-4308
Mailing Address - Fax:
Practice Address - Street 1:LANDSTUHL DENTAL ACTIVITY, HQ
Practice Address - Street 2:MARCEAU KASERNE BLDG 3703, RM 205
Practice Address - City:LANDSTUHL
Practice Address - State:KIRCHBERG
Practice Address - Zip Code:09180
Practice Address - Country:DE
Practice Address - Phone:0637-192-9130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH010397124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist