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General NPI Number Information
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NPI Number | 1629422076
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Entity Type | Organization
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Legal Business Name | RRG DENTAL, LLC
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 04/21/2016
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Provider Practice Location Address
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Address Line | 1410 RUSSELL RD SUITE 204
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City | PAOLI
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State | PA
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Zip | 19301-1200
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Country | US
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Telephone | 267-417-7501
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Fax |
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Provider Business Mailing Address
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Address Line | 833 N BETHLEHEM PIKE APT B
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City | AMBLER
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State | PA
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Zip | 19002-2524
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAJEEV GOWDA
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Credential |
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Telephone | 267-417-7501
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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 | DS036626
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License Number State | PA
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