Healthcare Provider Details

I. General information

NPI: 1760659544
Provider Name (Legal Business Name): GOPI K. VOONNA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELLIOT WAY
MANCHESTER NH
03103-3502
US

IV. Provider business mailing address

1 ELLIOT WAY
MANCHESTER NH
03103-3502
US

V. Phone/Fax

Practice location:
  • Phone: 603-625-8462
  • Fax: 603-669-2711
Mailing address:
  • Phone: 603-625-8462
  • Fax: 603-669-2711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberP51510
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number03846
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: