Provider Demographics
NPI:1609000314
Name:THOTA, GOPIKIRAN (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:GOPIKIRAN
Middle Name:
Last Name:THOTA
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 WAUGH DR # 986
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-3908
Mailing Address - Country:US
Mailing Address - Phone:832-202-8792
Mailing Address - Fax:
Practice Address - Street 1:117 LOUIS HENNA BLVD
Practice Address - Street 2:B230
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7343
Practice Address - Country:US
Practice Address - Phone:512-238-7449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246791223S0112X
OH30.022272122300000X
TX00246791223S0112X
TXN4160208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No208600000XAllopathic & Osteopathic PhysiciansSurgery