MEDICARE: ANUPAM M GATECHA BDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D12203	MN

General Provider Information

NPI Number	:	1164601324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANUPAM M GATECHA BDS

Provider Business Mailing Address
First Line	:	8511 JEFFERSON LN N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-2121
Country	:	US
Telephone Number	:	763-205-0526
Fax Number	:	763-205-0527

Provider Business Practice Location Address
First Line	:	8511 JEFFERSON LN N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-2121
Country	:	US
Telephone Number	:	763-205-0526
Fax Number	:	763-205-0527

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2007
Last Update Date	:	12/18/2014

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