MEDICARE: RESHMA M GOWDA DDS

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	122300000X	Dentist	5315008675	MI

General Provider Information

NPI Number	:	1881772127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RESHMA M GOWDA DDS

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

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

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	12/17/2018

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