Provider Demographics
NPI:1760699599
Name:GANDHI, DEVANG M (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEVANG
Middle Name:M
Last Name:GANDHI
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 1:2500 W FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-5144
Mailing Address - Country:US
Mailing Address - Phone:323-750-2082
Mailing Address - Fax:323-753-3435
Practice Address - Street 1:2500 W FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-5144
Practice Address - Country:US
Practice Address - Phone:323-750-2082
Practice Address - Fax:323-753-3435
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice