Healthcare Provider Details

I. General information

NPI: 1245977941
Provider Name (Legal Business Name): KAVERI KRANTI GANDHI MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8235 COUNTRY VILLAGE DR
INDIANAPOLIS IN
46214-3106
US

IV. Provider business mailing address

17011 ADLER LN
NOBLESVILLE IN
46060-0014
US

V. Phone/Fax

Practice location:
  • Phone: 317-676-6969
  • Fax:
Mailing address:
  • Phone: 513-857-9123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number12013856A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: