MEDICARE: N N GANDHI DDS LLC

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	DI017832	NJ

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	:	1699072777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	N N GANDHI DDS LLC

Provider Business Mailing Address
First Line	:	5005 BERGENLINE AVE
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-5563
Country	:	US
Telephone Number	:	201-866-0993
Fax Number	:	201-866-7707

Provider Business Practice Location Address
First Line	:	5005 BERGENLINE AVE
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-5563
Country	:	US
Telephone Number	:	201-866-0993
Fax Number	:	201-866-7707

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NARESHKUMAR N GANDHI
Credential	:	D.D.S
Telephone Number	:	201-866-0993

Provider Enumeration Date	:	02/25/2011
Last Update Date	:	02/25/2011

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