Provider Demographics
NPI:1962612366
Name:GANDY, KELARA NOORAEE (DDS)
Entity type:Individual
Prefix:DR
First Name:KELARA
Middle Name:NOORAEE
Last Name:GANDY
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 1:5967 SHY DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4841
Mailing Address - Country:US
Mailing Address - Phone:214-387-0404
Mailing Address - Fax:
Practice Address - Street 1:8811 TEEL PARKWAY
Practice Address - Street 2:SUITE 270
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:972-335-3000
Practice Address - Fax:972-335-3499
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice