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General NPI Number Information
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NPI Number | 1881097004
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Entity Type | Organization
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Legal Business Name | BHARATHI GORTHI DDS INC
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 665 S KNICKERBOCKER DR 9
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City | SUNNYVALE
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State | CA
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Zip | 94087-1033
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Country | US
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Telephone | 408-634-3368
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Fax | 408-739-2928
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Provider Business Mailing Address
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Address Line | 665 S KNICKERBOCKER DR 9
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City | SUNNYVALE
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State | CA
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Zip | 94087-1033
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Country | US
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Telephone | 408-634-3368
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Fax | 408-739-2928
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Authorized Official
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Title or Position | CEO
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Name | DR. BHARATHI GORTHI
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Credential | DDS
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Telephone | 408-634-3368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 57002
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License Number State | CA
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