Provider Demographics
NPI:1376651893
Name:GOWDA, VANITHA (DDS)
Entity Type:Individual
Prefix:
First Name:VANITHA
Middle Name:
Last Name:GOWDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:VANITHA
Other - Middle Name:
Other - Last Name:GOWDA-ARDILA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2160 N COIT RD
Mailing Address - Street 2:#140
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2287
Mailing Address - Country:US
Mailing Address - Phone:214-570-9993
Mailing Address - Fax:214-570-9750
Practice Address - Street 1:2160 N COIT RD
Practice Address - Street 2:#140
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2287
Practice Address - Country:US
Practice Address - Phone:214-570-9993
Practice Address - Fax:214-570-9750
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX191021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice