Active NPI
Vivek Gandotra, DDS
- Dentist
- Las Vegas, NV
National Provider Identifier
1013054931
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 5625
- Practice address
- 2212 S Eastern Ave
Las Vegas, NV 89104-4124 - Phone
- (702) 220-9908
- Fax
- (702) 220-4471
- NPI assigned
- Jan 31, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5625 | NV | Primary |
Addresses
Primary practice location
2212 S Eastern Ave
Las Vegas, NV 89104-4124
Mailing address
3325 Research Way
Carson City, NV 89706-7913
Phone (775) 888-6610
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100504768 | Medicaid | NV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160527001631 | NV | Order and Referring Only - Dentist | 0941590293 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5625 | NV | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344902400000",
"number": "1013054931",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3325 RESEARCH WAY",
"city": "CARSON CITY",
"state": "NV",
"postal_code": "897067913",
"telephone_number": "775-888-6610",
"fax_number": "775-887-7046"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2212 S EASTERN AVE",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891044124",
"telephone_number": "702-220-9908",
"fax_number": "702-220-4471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANDOTRA",
"first_name": "VIVEK",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-31",
"last_updated": "2012-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NV",
"license": "5625",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100504768",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.