Healthcare Provider Details

I. General information

NPI: 1811459332
Provider Name (Legal Business Name): GAIDUCHIK DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5740 WINDMILL WAY STE 16
CARMICHAEL CA
95608-1379
US

IV. Provider business mailing address

1521 E ST
SACRAMENTO CA
95814-1604
US

V. Phone/Fax

Practice location:
  • Phone: 916-331-0841
  • Fax:
Mailing address:
  • Phone: 916-444-6482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ANDREY GAIDUCHIK
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 916-396-8329