Provider Demographics
NPI:1063729663
Name:GAJENDRAN, BOBBY (DDS)
Entity type:Individual
Prefix:MRS
First Name:BOBBY
Middle Name:
Last Name:GAJENDRAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VALLEY RD
Mailing Address - Street 2:UNIT 201
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2837
Mailing Address - Country:US
Mailing Address - Phone:801-835-2359
Mailing Address - Fax:
Practice Address - Street 1:1 VALLEY RD
Practice Address - Street 2:UNIT 201
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2837
Practice Address - Country:US
Practice Address - Phone:801-835-2359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0384341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice