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General NPI Number Information
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NPI Number | 1477725539
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Entity Type | Organization
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Legal Business Name | MANISHKUMAR R GANDHI DDS PC
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Dates
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Enumeration Date | 03/29/2008
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Last Update Date | 03/29/2008
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Provider Practice Location Address
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Address Line | 1952 W CERMAK RD
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City | CHICAGO
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State | IL
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Zip | 60608-4204
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Country | US
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Telephone | 773-376-8444
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Fax |
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Provider Business Mailing Address
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Address Line | 716 MIDWEST CLUB PKWY
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City | OAK BROOK
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State | IL
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Zip | 60523-2531
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Country | US
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Telephone | 773-376-8444
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MANISHKUMAR R GANDHI
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Credential | DDS
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Telephone | 773-376-8444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 19015777
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License Number State | IL
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