Healthcare Provider Details

I. General information

NPI: 1003725508
Provider Name (Legal Business Name): SOWMYA GOURU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 TANGLEWOOD PKWY N STE K
ELIZABETH CITY NC
27909-9631
US

IV. Provider business mailing address

103 TANGLEWOOD PKWY N STE K
ELIZABETH CITY NC
27909-9631
US

V. Phone/Fax

Practice location:
  • Phone: 252-335-4341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14758
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: