Provider Demographics
NPI:1659437911
Name:GANDHI, PANNA DEEPAK (DDS)
Entity Type:Individual
Prefix:DR
First Name:PANNA
Middle Name:DEEPAK
Last Name:GANDHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-6961
Mailing Address - Country:US
Mailing Address - Phone:718-716-5711
Mailing Address - Fax:718-716-5705
Practice Address - Street 1:1731 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-6961
Practice Address - Country:US
Practice Address - Phone:718-716-5711
Practice Address - Fax:718-716-5705
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0354691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00514521Medicaid