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General NPI Number Information
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NPI Number | 1881208478
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Entity Type | Individual
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Provider Name | POORNIMA SWAMY GANGAJI DMD
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Gender | Female
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 10/05/2020
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Provider Practice Location Address
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Address Line | 760 N, ILLINOIS RTE 59 STE100
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City | NAPERVILLE
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State | IL
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Zip | 60563
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Country | US
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Telephone | 630-333-9571
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Fax |
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Provider Business Mailing Address
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Address Line | 1568 PALOMINO DR
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City | AURORA
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State | IL
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Zip | 60502-9666
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Country | US
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Telephone | 312-806-1895
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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 | 019.032807
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.032807
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License Number State | IL
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