MEDICARE: MIRAL NANDKISHOR GANDHI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DS043604	PA

General Provider Information

NPI Number	:	1215676721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRAL NANDKISHOR GANDHI DMD

Provider Business Mailing Address
First Line	:	121 S 43RD ST APT 108
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3195
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 WILLIAM PENN HWY
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-5006
Country	:	US
Telephone Number	:	610-923-0000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2022
Last Update Date	:	06/06/2022

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