CARLO IVAN GWARDSCHALADSE , PA in HAWTHORNE - NPI - 1386639441
CARLO IVAN GWARDSCHALADSE is a dentist based out of VALHALLA,New York CARLO practices in HAWTHORNE,New York and has the professional credentials of PA .The NPI Number for CARLO IVAN GWARDSCHALADSE is 1386639441 and he holds a Licence No. 5375(New York).
CARLO current practice location address is 95 GRASSLANDS RD,MUNGER PAVILION,VALHALLA,New York and he can be reached out via phone at 9143450162 and via fax at9143474401. You can also correspond with CARLO IVAN GWARDSCHALADSE through mail at his mailing address at19 BRADHURST AVE,,HAWTHORNE,New York – 105322139 (mailing address contact number – 105951652).
Provider Profile Details
| NPI Number | 1386639441 |
| Provider Name | CARLO IVAN GWARDSCHALADSE |
| PA | |
| Gender | 39573 |
| Provider Entity Type | Individual |
| Provider Enumeration Date | 363A00000X |
| Last Update Date | 38610 |
Provider Business Mailing Address Details
| Address | 95 GRASSLANDS RD,MUNGER PAVILION |
| City | VALHALLA |
| State | New York |
| Zip | 105951652 |
| Phone Number | 9144937621 |
Provider Business Practice Location Address Details
| Address | 19 BRADHURST AVE, |
| City | HAWTHORNE |
| State | New York |
| Zip | 105322139 |
| Phone Number | 9143450162 |
Provider's Primary Taxonomy Details
| Taxonomy | 363A00000X |
| License No. | 5375 |
| State | New York |