Provider Demographics
NPI:1275409773
Name:GAJENDRAGADKAR DENTAL CORP
Entity type:Organization
Organization Name:GAJENDRAGADKAR DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SURABHI
Authorized Official - Middle Name:
Authorized Official - Last Name:GAJENDRAGADKAR
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, MPH,DDS
Authorized Official - Phone:218-730-7644
Mailing Address - Street 1:32 LACEBARK
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2243
Mailing Address - Country:US
Mailing Address - Phone:218-730-7644
Mailing Address - Fax:
Practice Address - Street 1:23141 MOULTON PKWY STE 211
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1204
Practice Address - Country:US
Practice Address - Phone:949-916-0568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty