Healthcare Provider Details

I. General information

NPI: 1982178513
Provider Name (Legal Business Name): RAVINDER SINGH BOPARAI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3874 VINEYARD DR
DUNKIRK NY
14048-3559
US

IV. Provider business mailing address

760 BROADWAY RM 2C319
BROOKLYN NY
11206-5317
US

V. Phone/Fax

Practice location:
  • Phone: 718-363-7800
  • Fax:
Mailing address:
  • Phone: 718-936-8310
  • Fax: 718-630-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number061060
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: