Provider Demographics
NPI:1891089603
Name:MAHINDRA, GAURAV (DDS)
Entity Type:Individual
Prefix:DR
First Name:GAURAV
Middle Name:
Last Name:MAHINDRA
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 1:443 W 44TH ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4460
Mailing Address - Country:US
Mailing Address - Phone:516-343-4812
Mailing Address - Fax:
Practice Address - Street 1:630 9TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-3708
Practice Address - Country:US
Practice Address - Phone:212-265-6419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY055737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program