Basic Information
| Provider Information | |||||||||
| NPI: | 1417696279 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GANDHI | ||||||||
| FirstName: | RADHA | ||||||||
| MiddleName: | VARUN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | DDS | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PATEL | ||||||||
| OtherFirstName: | RADHA | ||||||||
| OtherMiddleName: | GAURANGKUMAR | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 100 BADGER CREEK CT | ||||||||
| Address2: | |||||||||
| City: | EL DORADO HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957629535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4089300499 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1276 HALYARD DR | ||||||||
| Address2: | |||||||||
| City: | W SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956913412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164542345 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2022 | ||||||||
| LastUpdateDate: | 05/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.