Provider Demographics
NPI:1588402093
Name:GANDHI, MIRA (DDS)
Entity type:Individual
Prefix:
First Name:MIRA
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 1:2900 7TH AVE S APT 221
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-2938
Mailing Address - Country:US
Mailing Address - Phone:706-987-3421
Mailing Address - Fax:
Practice Address - Street 1:202 INVERNESS CENTER DR STE 301
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35242-7636
Practice Address - Country:US
Practice Address - Phone:205-991-8939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.007362-C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist