Provider Demographics
NPI:1659404069
Name:GAYDOS, JOANNE MARIE (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:MARIE
Last Name:GAYDOS
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8388 E 116TH ST
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1596
Mailing Address - Country:US
Mailing Address - Phone:317-849-5853
Mailing Address - Fax:317-849-5751
Practice Address - Street 1:8388 E 116TH ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1596
Practice Address - Country:US
Practice Address - Phone:317-849-5853
Practice Address - Fax:317-849-5751
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120095621223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics