Provider Demographics
NPI:1316179922
Name:GATHA, KINJEL (DDS)
Entity type:Individual
Prefix:
First Name:KINJEL
Middle Name:
Last Name:GATHA
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 1:26910 GRAND CENTRAL PKWY
Mailing Address - Street 2:BUILDING 3, APARTMENT 3S
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11005-1045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26910 GRAND CENTRAL PKWY
Practice Address - Street 2:BUILDING 3, APARTMENT 3S
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11005-1045
Practice Address - Country:US
Practice Address - Phone:516-562-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50 055133122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist