Healthcare Provider Details

I. General information

NPI: 1407269475
Provider Name (Legal Business Name): VANISHA AMRATLAL GANDHI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2014
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 CAPP ST
SAN FRANCISCO CA
94110-1210
US

IV. Provider business mailing address

160 CAPP ST
SAN FRANCISCO CA
94110-1210
US

V. Phone/Fax

Practice location:
  • Phone: 415-621-8051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number64947
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: