Provider Demographics
NPI:1124336086
Name:MAHESH GONDI D.M.D. PLLC
Entity type:Organization
Organization Name:MAHESH GONDI D.M.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHESH
Authorized Official - Middle Name:B
Authorized Official - Last Name:GONDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-242-0696
Mailing Address - Street 1:2440 N JOSEY LN
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-1668
Mailing Address - Country:US
Mailing Address - Phone:972-242-0696
Mailing Address - Fax:972-242-2399
Practice Address - Street 1:2440 N JOSEY LN
Practice Address - Street 2:#103
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-1668
Practice Address - Country:US
Practice Address - Phone:972-242-0696
Practice Address - Fax:972-242-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22213261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental