Provider Demographics
NPI:1487816252
Name:GOKHALE, POONAM A (DMD)
Entity Type:Individual
Prefix:DR
First Name:POONAM
Middle Name:A
Last Name:GOKHALE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5261 MCKINNEY RANCH PKWY
Mailing Address - Street 2:STE # 400
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6831
Mailing Address - Country:US
Mailing Address - Phone:214-544-7645
Mailing Address - Fax:972-548-9368
Practice Address - Street 1:5261 MCKINNEY RANCH PKWY
Practice Address - Street 2:STE # 400
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-6831
Practice Address - Country:US
Practice Address - Phone:214-544-7645
Practice Address - Fax:972-548-9368
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice