Provider Demographics
NPI:1386890390
Name:GANDHI, AVANI (DDS)
Entity type:Individual
Prefix:DR
First Name:AVANI
Middle Name:
Last Name:GANDHI
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 1:17202 DE GROOT PL
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-1121
Mailing Address - Country:US
Mailing Address - Phone:415-810-6545
Mailing Address - Fax:
Practice Address - Street 1:17202 DE GROOT PL
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-1121
Practice Address - Country:US
Practice Address - Phone:415-810-6545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-09
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50 0540051223P0221X
CA569351223P0221X
TX252521223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry