MEDICARE: DR. RESHMA GOWDA P.C.

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	17968	MI

General Provider Information

NPI Number	:	1790949410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. RESHMA GOWDA P.C.

Provider Business Mailing Address
First Line	:	2950 E WATTLES RD
Second Line	:	# 200
City	:	TROY
State	:	MI
Zip	:	48085-7008
Country	:	US
Telephone Number	:	248-526-9680
Fax Number	:	248-526-9682

Provider Business Practice Location Address
First Line	:	2950 E WATTLES RD
Second Line	:	# 200
City	:	TROY
State	:	MI
Zip	:	48085-7008
Country	:	US
Telephone Number	:	248-526-9680
Fax Number	:	248-526-9682

Authorized Official
Title or Position	:	DDS
Name	:	RESHMA GOWDA
Credential	:	DDS
Telephone Number	:	248-526-9680

Provider Enumeration Date	:	07/11/2008
Last Update Date	:	07/14/2008

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