MEDICARE: DR. SANJEEV K GOPALAKRISHNAN D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	22113	TX

General Provider Information

NPI Number	:	1700941184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANJEEV K GOPALAKRISHNAN D.D.S

Provider Business Mailing Address
First Line	:	1432 AUSTIN HWY STE 107
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-4903
Country	:	US
Telephone Number	:	210-822-5747
Fax Number	:	210-822-2738

Provider Business Practice Location Address
First Line	:	1432 AUSTIN HWY STE 107
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-4903
Country	:	US
Telephone Number	:	210-822-5747
Fax Number	:	210-822-2738

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	05/13/2011

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