Provider Demographics
NPI:1760155576
Name:GANDARA DENTAL
Entity Type:Organization
Organization Name:GANDARA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:GANDARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:857-249-8324
Mailing Address - Street 1:13728 SW 84TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4000
Mailing Address - Country:US
Mailing Address - Phone:305-456-7383
Mailing Address - Fax:
Practice Address - Street 1:13728 SW 84TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4000
Practice Address - Country:US
Practice Address - Phone:305-456-7383
Practice Address - Fax:305-676-9028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental