Provider Demographics
NPI:1841303526
Name:SAMBASIVAN, GAYATHRI (DDS)
Entity type:Individual
Prefix:DR
First Name:GAYATHRI
Middle Name:
Last Name:SAMBASIVAN
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Gender:F
Credentials:DDS
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Mailing Address - Street 1:6600 CLEARWATER DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9468
Mailing Address - Country:US
Mailing Address - Phone:952-932-0920
Mailing Address - Fax:952-932-0929
Practice Address - Street 1:7373 FRANCE AVE SO
Practice Address - Street 2:SUITE 402
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4598
Practice Address - Country:US
Practice Address - Phone:952-831-4400
Practice Address - Fax:952-893-3041
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN116041223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry