MEDICARE: DR. PANNA DEEPAK GANDHI DDS

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	035469	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659437911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PANNA DEEPAK GANDHI DDS

Provider Business Mailing Address
First Line	:	1731 UNIVERSITY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453-6961
Country	:	US
Telephone Number	:	718-716-5711
Fax Number	:	718-716-5705

Provider Business Practice Location Address
First Line	:	1731 UNIVERSITY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453-6961
Country	:	US
Telephone Number	:	718-716-5711
Fax Number	:	718-716-5705

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

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	09/06/2023

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