Basic Information
| Provider Information | |||||||||
| NPI: | 1003293416 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GANDIA | ||||||||
| FirstName: | CASSANDRA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.D.S. M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 810 ABBOTT BLVD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | FORT LEE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070244151 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 92 EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | RIDGEFIELD PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076601912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012243600 | ||||||||
| FaxNumber: | 2012245435 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2015 | ||||||||
| LastUpdateDate: | 01/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 22DI02575602 | NJ | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.