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General NPI Number Information
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NPI Number | 1023495348
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Entity Type | Individual
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Provider Name | NIKHILESH RAO GORUKANTI DMD
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Gender | Male
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 05/19/2015
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Provider Practice Location Address
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Address Line | 594 CENTRE ST APT 1
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-2560
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Country | US
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Telephone | 617-522-8005
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Fax |
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Provider Business Mailing Address
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Address Line | 231 HARRISON AVE APT 16
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City | BOSTON
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State | MA
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Zip | 02111-1857
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Country | US
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Telephone | 908-698-3206
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1856869
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License Number State | MA
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