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General NPI Number Information
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NPI Number | 1003044082
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Entity Type | Individual
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Provider Name | GANDY S GARCIA D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/29/2009
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Last Update Date | 06/29/2009
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Provider Practice Location Address
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Address Line | 3915 W 26TH ST
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City | CHICAGO
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State | IL
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Zip | 60623-3704
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Country | US
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Telephone | 773-522-2929
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Fax | 773-522-2930
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Provider Business Mailing Address
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Address Line | 1216 N 24TH AVE
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City | MELROSE PARK
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State | IL
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Zip | 60160-3017
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Country | US
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Telephone | 773-732-3477
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019028036
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019028036
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License Number State | IL
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