Provider Demographics
NPI:1437300134
Name:GOURI, ANITA J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:J
Last Name:GOURI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ANITA
Other - Middle Name:JAYAGOPAL
Other - Last Name:GOURI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1512 CAMELLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:337-443-9944
Mailing Address - Fax:337-981-7505
Practice Address - Street 1:1512 CAMELLIA BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-443-9944
Practice Address - Fax:337-981-7505
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA57551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry