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General NPI Number Information
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NPI Number | 1699308619
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Entity Type | Organization
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Legal Business Name | GAURAV DUDEJA PLLC
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Dates
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Enumeration Date | 02/18/2020
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Last Update Date | 02/10/2021
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Provider Practice Location Address
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Address Line | 5038 TACOMA MALL BLVD STE A
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City | TACOMA
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State | WA
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Zip | 98409-7103
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Country | US
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Telephone | 210-861-5541
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Fax |
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Provider Business Mailing Address
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Address Line | 5038 TACOMA MALL BLVD STE A
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City | TACOMA
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State | WA
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Zip | 98409-7103
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Country | US
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Telephone | 253-473-2166
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | GAURAV DUDEJA
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Credential |
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Telephone | 210-861-5541
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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 |
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License Number State |
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