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General NPI Number Information
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NPI Number | 1073798575
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Entity Type | Individual
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Provider Name | SEJAL GHODADRA D.M.D
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Gender | Female
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 01/02/2008
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Provider Practice Location Address
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Address Line | 1520 CHERRY CREEK CV
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City | HENDERSON
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State | TN
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Zip | 38340-1578
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Country | US
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Telephone | 731-989-2763
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Fax |
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Provider Business Mailing Address
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Address Line | 1520 CHERRY CREEK CV
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City | HENDERSON
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State | TN
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Zip | 38340-1578
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Country | US
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Telephone | 731-989-2763
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DS0000008434
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License Number State | TN
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