Provider Demographics
NPI:1275924995
Name:PRATIMA S. GOWDAR, DDS, INC
Entity Type:Organization
Organization Name:PRATIMA S. GOWDAR, DDS, INC
Other - Org Name:SMILE OCEAN DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRATIMA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOWDAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-483-3302
Mailing Address - Street 1:4655 CASS ST. STE 104,
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109
Mailing Address - Country:US
Mailing Address - Phone:858-483-3302
Mailing Address - Fax:858-483-3180
Practice Address - Street 1:4655 CASS ST. STE 104,
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109
Practice Address - Country:US
Practice Address - Phone:858-483-3302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty