MEDICARE: SONAL K. GANDHI D.D.S. P.C.

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	1223G0001X	General Practice Dentistry	019020759	IL

General Provider Information

NPI Number	:	1346230620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONAL K. GANDHI D.D.S. P.C.

Provider Business Mailing Address
First Line	:	7804 DORCHESTER LN
Second Line	:
City	:	DARIEN
State	:	IL
Zip	:	60561-4861
Country	:	US
Telephone Number	:	630-654-3906
Fax Number	:

Provider Business Practice Location Address
First Line	:	7804 DORCHESTER LN
Second Line	:
City	:	DARIEN
State	:	IL
Zip	:	60561-4861
Country	:	US
Telephone Number	:	630-654-3906
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. SONAL K GANDHI
Credential	:	D.D.S.
Telephone Number	:	630-654-3906

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	02/17/2010

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