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General NPI Number Information
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NPI Number | 1538383955
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Entity Type | Organization
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Legal Business Name | ROOPA GOWDA PROFESSIONAL DENTAL INC
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 09/04/2014
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Provider Practice Location Address
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Address Line | 43430 E. FLORIDA AVE, STE A
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City | HEMET
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State | CA
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Zip | 92544-5298
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Country | US
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Telephone | 951-927-0100
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Fax | 951-927-1237
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Provider Business Mailing Address
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Address Line | 43430 E. FLORIDA AVE, STE A
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City | HEMET
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State | CA
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Zip | 92544-5298
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Country | US
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Telephone | 951-927-0100
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Fax | 951-927-1237
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROOPA S GOWDA
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Credential | D.D.S.
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Telephone | 951-927-0100
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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 | 40859
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License Number State | CA
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