Provider Demographics
NPI:1770830838
Name:GANDLER, RACHEL KAREN (DMD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:KAREN
Last Name:GANDLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6722 N HASLAM AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0912
Mailing Address - Country:US
Mailing Address - Phone:559-287-2412
Mailing Address - Fax:
Practice Address - Street 1:3156 STEINWAY ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3909
Practice Address - Country:US
Practice Address - Phone:914-393-8830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056198122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist