Provider Demographics
NPI:1497938112
Name:RAVINDER K GAMPA DDS INC
Entity Type:Organization
Organization Name:RAVINDER K GAMPA DDS INC
Other - Org Name:WEST CARROLLTON FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAVINDER
Authorized Official - Middle Name:K
Authorized Official - Last Name:GAMPA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-294-0468
Mailing Address - Street 1:5515 SPRINGBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449
Mailing Address - Country:US
Mailing Address - Phone:937-294-0468
Mailing Address - Fax:937-294-4266
Practice Address - Street 1:5515 SPRINGBORO PIKE
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449
Practice Address - Country:US
Practice Address - Phone:937-294-0468
Practice Address - Fax:937-294-4266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2416353Medicaid