Healthcare Provider Details

I. General information

NPI: 1235125774
Provider Name (Legal Business Name): RUPA HAMAL D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 CHERRY WAY DR STE 100
GAHANNA OH
43230-6780
US

IV. Provider business mailing address

1329 CHERRY WAY DR STE 100
GAHANNA OH
43230-6780
US

V. Phone/Fax

Practice location:
  • Phone: 161-447-8334
  • Fax: 614-478-3345
Mailing address:
  • Phone: 614-532-8755
  • Fax: 614-532-8756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number21629
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: