Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DI 18699 | NJ |
NPI | 1003995622 |
---|---|
Provider Name | Dr. Mayank Gadhia |
First Address | Lodi, NJ 07644-3837 |
Second Address | Lodi, NJ 07644-3837 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 08/07/2007 |