Provider Demographics
NPI:1073636221
Name:VARMA, GOPIMANOHAR NANGIR (DMD)
Entity Type:Individual
Prefix:
First Name:GOPIMANOHAR
Middle Name:NANGIR
Last Name:VARMA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1101
Mailing Address - Country:US
Mailing Address - Phone:215-393-9008
Mailing Address - Fax:215-393-9015
Practice Address - Street 1:1011 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1101
Practice Address - Country:US
Practice Address - Phone:215-393-9008
Practice Address - Fax:215-393-9015
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030719L122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019584070002Medicaid
PA0195840701Medicaid