Provider Demographics
NPI:1679587752
Name:GANDY, WILLIAM E (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:GANDY
Suffix:
Gender:M
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:PO BOX 630792
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-0792
Mailing Address - Country:US
Mailing Address - Phone:936-564-1972
Mailing Address - Fax:936-564-3622
Practice Address - Street 1:824 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4616
Practice Address - Country:US
Practice Address - Phone:936-564-1972
Practice Address - Fax:936-564-3622
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9908122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist